Preamble

The House met at half-past Two o'clock

PRAYERS

[Mr. SPEAKER in the Chair]

PRIVATE BUSINESS

CROMARTY PETROLEUM ORDER CONFIRMATION BILL (By Order)

Order for consideration read.

To be considered upon Thursday.

Oral Answers to Questions — DEFENCE

BAOR (Cost)

Mr. Gwilym Roberts: asked the Secretary of State for Defence what are the latest figures available for the costs and numbers of British forces stationed in Germany; and what progress has been made in obtaining offsetting payments.

Mr. Ronald Atkins: asked the Secretary of State for Defence when he will announce the new offset agreement with West Germany on the costs of the British Army of the Rhine.

Mr. Newens: asked the Secretary of State for Defence if any further discussions have taken place with the West German Government about the costs of BAOR during the course of recent months; and if he will make a statement.

The Secretary of State for Defence (Mr. Frederick Mulley): We are still in touch with the Federal German Government and I cannot predict when an agreement will be concluded. I have nothing to add to the figures given to my hon. Friend the Member for Cannock (Mr. Roberts) on 13th July regarding the costs and number of British forces stationed in Germany.

Mr. Roberts: I congratulate my right hon. Friend on his recent appointment. Does he not feel that it is absolutely absurd that one of the weakest economies in Europe—that of Britain—should be subsidising in this way the wealthiest economy in Europe, that of Germany? Is it not time we told the Germans "Either pay up or we get out"?

Mr. Mulley: I am obliged to my hon. Friend for his personal good wishes. Whilst I would not necessarily adopt his language or tactics, I attach great importance to a successful outcome to these negotiations.

Mr. Younger: Is not the right hon. Gentleman aware that the reason why he is having difficulty in getting agreement with the Germans to increase their contribution is that we have repeatedly cut our defence contribution to the Alliance in the face of all our allies and the facts of the world situation?

Mr. Mulley: I think that the hon. Gentleman is a bit short on facts himself. We are fully in accord with the Brussels Treaty commitment of 55,000 troops and a tactical air force. As the hon. Gentleman should know, the defence review conducted by my predecessor was on the basis of the commitment of practically the whole of our forces to the Alliance.

Mr. Atkins: Does not my right hon. Friend agree that we have repeatedly had trouble with the Germans ever since the Brussels Treaty was signed, and that during this period we have been filched of thousands of millions of pounds, most of it at great cost to the British balance of payments? It was a major factor in the past and still is an important factor.

Mr. Mulley: I agree that the balance of payments element presents particular difficulties to us, not least at this time, but the stationing of forces in Germany is part of NATO's general defence posture and is not solely to the benefit of one particular country.

Mr. Newens: Can my right hon. Friend give any figures which would show the effect of the recent depreciation of sterling against the deutschemark on the real cost to this country of maintaining this army? Is it not time that Conservative Members, who are continually saying that we cannot afford to pay to meet the needs


of people who want housing and health and welfare services, turned their attention to this wasteful expenditure? Unless a change can be made, is it not time we began to withdraw our forces from Western Europe?

Mr. Mulley: I do not accept that the expenditure is wasteful, although I accept that the foreign exchange burden is particularly heavy, not least at the present time. The budgetary cost of our forces in Germany is about £600 million. The foreign exchange element at the beginning of the financial year was estimated to be £413 million, but obviously, since the pound has depreciated by about 20 per cent. against the deutschemark, the cost both in foreign exchange and in budgetary terms will be increased as a result. It is impossible to give an estimate as to the outturn of the financial year.

Rear-Admiral Morgan-Giles: I join in the congratulations to the new Secretary of State. He said that my hon. Friend the Member for Ayr (Mr. Younger) was short on facts, but surely he will not start his period in office in the belief that our allies are happy about the cuts his Government have undertaken.

Mr. Mulley: I accept that no one is happy. I have never met a soldier, sailor or airman who could not make a most convincing case for additional expenditure, just as in my previous job I never met anyone in education who could not make a case for further public expenditure. We hear from the Opposition Benches a constant scream about the total of public expenditure but opposition to every attempt to reduce it in a particular case.

Mr. Fernyhough: Does my right hon. Friend realise that, when he says that negotiations are proceeding and that he hopes for a successful conclusion, that is the kind of answer I have been receiving ever since the Brussels Treaty was signed in 1954? As the deficit now amounts to £1,200 million or £1,300 million, and having regard to the state of our respective economies, will my right hon. Friend make it clear to the Germans in the negotiations that we can no longer continue to bear this burden and that they are in breach of the treaty they signed in 1954?

Mr. Mulley: There is no treaty commitment on the part of the Federal Republic of Germany for offset commitments, but I can tell my right hon. Friend that some offset negotiations were concluded. Indeed, I concluded two particular sets of such negotiations myself in the late 1960s. I shall certainly bear in mind the strength of feeling that I know exists that we should have a satisfactory outcome to the present negotiations.

Mr. Onslow: I also welcome the right hon. Gentleman back to the subject of defence. I am a little surprised that he has not already understood that he will get much more support for his duty of maintaining adequate defences in this country and for Europe from these Benches than he can expect from the Government Benches. He will not, I think, need to be told that again after this afternoon.
Does the Secretary of State regard the likelihood of our concluding an agreement on offset with the Germans as being connected with the ability of the Americants to reconclude a similar agreement between themselves and the Germans?

Mr. Mulley: I thank the hon. Gentleman for his kind personal remarks. I do not think there is any connection between the American offset arrangement and our own. Indeed, some arrangement was made in the summer, not exactly of an offset character, between the American Government and the German Government whereby the Germans are paying some part of the American costs of repositioning a brigade, but I do not think that the two items are necessarily connected.

Junior Soldiers (Discharge)

Mr. Andrew F. Bennett: asked the Secretary of State for Defence if he is satisfied with the arrangements whereby boy soldiers can get their discharge prior to their eighteenth birthday.

The Under-Secretary of State for Defence for the Army (Mr. Robert C. Brown): Yes, Sir. As I told the House on 22nd July 1975, this matter was fully reviewed by Lord Donaldson's Committee on Boy Entrants and Young Servicemen, and the Army's terms of engagement now incorporate certain options


designed to safeguard the interests of junior entrants.

Mr. Bennett: I thank my hon. Friend for that reply and for the sympathy he has shown to one of my constituents. Will he not agree, however, that the easiest and fairest way to ensure that young soldiers are not tricked into staying in the Army would be to get them to sign a positive agreement on their eighteenth birthday committing them to stay in, rather than the present arrangement by which they have to make an approach prior to their eighteenth birthday if they wish to leave the Army?

Mr. Brown: As my hon. Friend knows, a junior soldier has the right, for six months after entry, to leave the Army at any time within that period at a fortnight's notice if he so desires. A junior entrant also has the right, on reaching his eighteenth birthday, of either confirming his original commitment to service or electing to reduce his period of service to three years, counting from his eighteenth birthday. I do not think we can go much further than this.

Mr. Litterick: Does not my hon. Friend agree that it is an offence against natural justice that a minor should have a contract of service made for him which he is unable to repudiate when he reaches the age of 18? At present, that right is constrained. Will not my hon. Friend agree that it would be simpler and fairer for everyone concerned if these young soldiers were given the same rights as everyone else?

Mr. Brown: No, Sir. Enlistment in the Armed Forces does not involve entering into a contract. The engagement of members of the Armed Forces is at the discretion of the Crown. Consequently, the law relating to contracts as it affects entrants does not apply.

Airborne Early Warning System

Mr. Arnold: asked the Secretary of State for Defence whether he is satisfied with the current level of funding for the development of an AEW Nimrod.

Mr. Tebbit: asked the Secretary of State for Defence if he will make a statement on the progress made towards the

choice of replacement United Kingdom and NATO airborne early warning systems.

The Minister of State, Ministry of Defence (Dr. John Gilbert): At the June 1976 meeting of the NATO Defence Planning Committee, Ministers decided that further comprehensive proposals for a NATO airborne early warning system should be presented to them at the next DPC meeting in December. Work on this is in hand. In the meantime, we are continuing to finance initial development work on the Nimrod option.

Mr. Arnold: Is it not the case that an AEW Nimrod would cost much less than AWACS? Have the Government now arrived at contract definition for the Boeing E3A, and, if so, on what cost effectiveness is it based?

Dr. Gilbert: A great deal of work still remains to be done in determining what would be the total cost of either option. We are certainly not in a position to take any decision before the December meeting, although we are well aware of the urgency—and we have impressed this on our NATO allies—of getting an agreement as soon as possible.

Dr. M. S. Miller: If we must spend a great deal of money on sophisticated weapons—and I take no pleasure in conceding that we must—will not my hon. Friend at least ensure that it is British technology and British factories which produce the goods required? Will he push for Nimrod in the belief that it is as good as anything which could be supplied by any other country?

Dr. Gilbert: I can assure my hon. Friend that we shall take very seriously into account the industrial implications of a choice for Nimrod or AWACS. I am sure he would be the first to appreciate that considerable advantages would flow from having a uniform NATO system, if we can get one agreed.

Mr. Tebbit: Has the Minister yet tumbled to the fact that if we purchased the Boeing AWACS it would mean the termination of a line of development which could not subsequently be reopened in this country? Will he therefore make it a precondition of such a purchase, if one is made, that a new line of collaborative development, with guaranteed sales in the


United States and among our other partners, will be opened up and that that collaborative venture will have British design leadership?

Dr. Gilbert: I do not know whether I tumbled to what the hon. Gentleman described as a fact, but clearly one looks at the range of collaborative possibilities between NATO partners over the whole field and does not take simply one example in isolation. Clearly, in a high technology development of this sort, if the decision goes one way rather than the other, certain options are foreclosed. This is to speak in platitudes with which the hon. Gentleman will be familiar. If one were to go for AWACS, one would be looking for further collaborative ventures in which the balance would be more in our favour.

Mr. Roper: Will my hon. Friend ensure that, if it is not possible to find a common airborne early warning system for the whole of NATO, the two systems will have a large degree of interoperability?

Dr. Gilbert: Certainly. As I am sure my hon. Friend will be aware, as he studies these things closely, the Nimrod system differs from the AWACS system, particularly in its characteristics in regard to overland or oversea capabilities. As I understand it, however, it would be possible to operate a split system without any problems of incompatibility.

Mr. Pattie: Does the Minister agree that, if the Government's decision is to support the AWACS project, this will mean cancelling the British project, with an effect on British technology and also eventually an effect on employment?

Dr. Gilbert: If I understand the hon. Gentleman correctly, obviously if we were to go for AWACS we would not go for Nimrod as well. But I emphasise that we are still some months away from having to take a decision either way.

Mr. Onslow: Will the hon. Gentleman explain why he thinks we are some months away from having to take a decision? Is he not aware that there is great pressure to get a decision on this by January? Is he also aware that there are other very important decisions which will be taken in the near future, in particular

the American decision on the XM-1 tank? Can he say whether he regards these as interlinked, or how he expects to be able to go on spinning matters out?

Dr. Gilbert: I think that the hon. Gentleman cannot have been listening to my earlier replies. I made it clear that we could not expect a decision until the next DPC meeting, which will be in December.

Mr. Onslow: That is not months away.

Dr. Gilbert: It is at least two months away. The hon. Gentleman cannot count. Secondly, while one would not wish to be specific in tying one project in with another, obviously one looks at the whole range of possible collaborative projects. It is very far from a question of our spinning things out. All the pressure at the moment for getting an early decision is coming from the British Government.

NATO

Mr. Blaker: asked the Secretary of State for Defence when he last met the other NATO Defence Ministers.

Mr. Goodlad: asked the Secretary of State for Defence when he next intends to meet his NATO counterparts.

Mr. Moate: asked the Secretary of State for Defence when he last met the other NATO Defence Ministers.

Mr. Mulley: I look forward to meeting the other NATO Defence Ministers at the NATO autumn ministerial meetings. The Nuclear Planning Group will meet in London on 17th and 18th November. Eurogroup Ministers will meet in Brussels on 6th December, and the Defence Planning Committee will meet there on 7th and 8th December.

Mr. Blaker: Does the Secretary of State recall that his predecessor made it clear in the House on 13th January of this year that if any defence cut jeopardised the security of the Western Alliance he would not accept it? Will the right hon. Gentleman take this opportunity to make it quite clear to our allies that his position is the same?

Mr. Mulley: I very much share my predecessor's view on these matters.


There are other Questions on the Order Paper about the NATO response to our recent intimation on our defence expenditure, and I shall deal with them when we reach them.

Mr. Frank Allaun: When my right hon. Friend meets the Defence Ministers, will he point out to them that France has recently decided to withdraw 10,000 of her 60,000 troops from West Germany, some of them to be demobbed immediately? If France can do that, why cannot Britain, bearing in mind that we are in a far worse financial position?

Mr. Mulley: My hon. Friend knows that France is in a rather different position from the rest of the Alliance in that her forces are not fully integrated with those of the other NATO countries. But I am sure he will also have noted that it is the intention in successive years for the French Government to increase their defence expenditure, and that is not my intention.

Mr. Townsend: Has the right hon. Gentleman discussed with his colleagues the impact of the decision announced in the White Paper to cut the fuel programme? Does not this have considerable implications for stockpiling in NATO and for training?

Mr. Mulley: Since I have not yet met my colleagues, I have not discussed this or any other matter with them.

Mr. Alan Lee Williams: Can my right hon. Friend confirm that at a recent meeting of the Eurogroup in The Hague a decision was taken on joint armaments procurement with a slight change enabling the French to co-operate in NATO? I understand that a meeting took place in Rome which the French attended.

Mr. Mulley: I am happy to say that the French play an important part in the new European Programme Committee, although they are not part of the original Eurogroup. We hope that, as a result of the work of the European Programme Committee, it will lead to greater collaboration in Europe on the procurement of equipment.

Mr. Ian Gilmour: In welcoming the Secretary of State and his hon. Friend the Minister of State to the Defence Department, may I ask the right hon.
Gentleman to undertake that when he meets NATO Ministers he will assure them that this Government will make no further cuts at all in defence?

Mr. Mulley: It is very difficult to be absolute, and even in Opposition the Conservative Party's posture is far from precise. I do not myself deal in absolute terms, and I would never in any circumstances give an absolute commitment which in the events which unfolded might be impossible to fulfil.

Mr. Peter Morrison: asked the Secretary of State for Defence whether he remains satisfied that he is able to fulfil Great Britain's NATO commitments.

Mr. Mulley: Yes, Sir.

Mr. Morrison: Are we to assume from the right hon. Gentleman's reply to my hon. Friend the Member for Blackpool, South (Mr. Blaker) that he in no way agrees with the argument propounded by his hon. Friends in the Tribune Group about our defence commitments?

Mr. Mulley: It is a little difficult to deal with particular groups because, like most groups, they have views of varying character. I stand by the defence review which has already been announced and the fact that the greater part of our forces are wholly committed to NATO, and it would be my intention not to weaken our commitment to the Alliance because the Alliance is an essential part of the defence of this country.

Mr. Robin F. Cook: Is not it intolerable cant by Opposition Members who only last night were stamping up and down the Chamber demanding cuts of £4,000 million, £6,000 million and £10,000 million in public expenditure now to be demanding that there should be no cuts in public expenditure? Can my right hon. Friend name a single country which has slashed expenditure on social and welfare services and maintained expenditure on defence, other than military dictatorships—[HON. MEMBERS: "Russia."]—absolutely, other than military dictatorships, which are able to oppress the popular will?

Mr. Mulley: I share my hon. Friend's concern about the Opposition's enthusiasm for the generality of reduction in public expenditure while, not only


in this area but in many other areas, objecting strongly when the impact of such reductions happens to be politically convenient to exploit. A number of countries have had to reduce their social expenditure and their defence expenditure as well. The great problem of this country is that our gross national product has not risen at a rate which would have made it possible to sustain all that we want to do on both defence and the social side as well.

Mr. Wall: Will the Secretary of State explain how the recent axing of specialised commando shipping, which necessitated the Government chartering civilian car ferries for a recent reinforcement exercise on the northern flank, can possibly be described as fulfilling NATO commitments?

Mr. Mulley: I do not think there is any NATO commitment specifying that personnel shall he carried only in ships of the Royal Navy. The requirement is that forces should be in the right place at the right times.

Mr. Cronin: Will my right hon. Friend bear in mind whenever the question of covering NATO commitments arises that the Soviet Union and the Warsaw Pact Powers have an overwhelming superiority in Eastern Europe which is explicable only in potentially aggressive terms?

Mr. Mulley: I am aware, as the whole House should be, of the difficulties which could arise from the increasing strength of the Warsaw Pact forces as they were set out clearly in my predecessor's White Paper earlier this year. At the same time, I would not expect that we could cope with it alone. That is why I regard the NATO Alliance as an essential element in the defence of this country.

Expenditure (NATO Representations)

Mr. Gow: asked the Secretary of State for Defence what recent representations he has received from other NATO Governments about the level of defence expenditure of the United Kingdom Government.

Mr. Mulley: I have not yet received the formal response from the Alliance to the information which we have provided on the reductions in planned defence expenditure that have been announced this year.

Mr. Gow: Will the Secretary of State take this opportunity to tell us that he regards it as being the Government's first duty to secure the territorial integrity of these islands against any possible assault? At the same time, will he confirm that, at a time when the Warsaw Pact countries are increasing their military strength, this is the wrong moment to be diminishing our own capability?

Mr. Mulley: I share the hon. Gentleman's concern that we should always be in a position to the maximum extent to ensure the defence of these islands. At the same time, I view with concern the evidence that we have of increased Soviet and Warsaw Pact expenditure. However, the defence review conducted by my predecessor was on the basis that we reduced commitments elsewhere and in support and ancillary purposes and that we did not reduce the very important and effective contribution that we make to the forces of NATO.

Mr. Frank Allaun: In wishing my right hon. Friend the Secretary of State well, may we hope that he will be as concerned about public expenditure as he was in his previous post? Will he refute the nonsense that Britain has slashed arms spending by billions and admit that there has been a real increase since last year?

Mr. Mulley: We have this argument —I had it in my previous post—about planned expenditure and actual expenditure. The reductions made by my predecessor on planned expenditure amounted to several billion pounds over a period of time. I do not intend in my present job to do what I did in my last job, which was to increase expenditure in real terms by 2 per cent. It is imperative that we go through with the reductions in defence which have been announced. Consistent with the defence of these islands and our contribution to NATO, I shall be looking for economies.

Mr. Ian Gilmour: I am sure that the right hon. Gentleman does not want to deceive the House. He must be aware that the Government's defence cuts so far have harmed our commitments in Europe both on the flanks and on the central front. It is really much too late to pretend otherwise.

Mr. Mulley: If we were able to do so, naturally we would like to do more on both the northern and southern flanks. The right hon. Gentleman knows, however, that NATO's demand of us is primarily our very important contribution to the central front together with the Tactical Air Force and our very substantial naval contribution in the Channel and the Eastern Atlantic.

Mr. Gilmour: I was saying that the Secretary of State appeared to imply that the cuts did not affect our contribution to NATO. That is quite untrue.

Mr. Mulley: The cuts are on the margin, and obviously there is room for argument here. NATO naturally would like us to increase our commitment, but, compared with the situation which we inherited in 1964, we are now up to our 55,000 commitment. In the early 1960s we were below our target in Germany.

Civilian Employment

Mr. Hooley: asked the Secretary of State for Defence how many civilian jobs will be affected by the decision, announced on 22nd July, to cut defence expenditure by a further £100 million; and which establishments will be most concerned.

Mr. Alan Clark: asked the Secretary of State for Defence how many civilian jobs he expects to be lost as a result of the decision to cut defence expenditure by a further £100 million.

Dr. Gilbert: The further cut of £100 million in defence expenditure which formed part of the public expenditure reductions announced in July will be achieved mainly by rephasing works and equipment programmes. It will have no effect on the numbers of Service personnel and is not expected to have any significant effect on the numbers of MOD civilian staff either. There will, however, be some reduction of job opportunities for non-MOD employees, mainly in the construction industries.

Mr. Hooky: Would my hon. Friend care to answer the Question and say how many civilian employees will be involved? What active steps are being taken between his Department and the Department of Employment to transfer these people into useful manufacturing industry?

Dr. Gilbert: I am not in a position to give an answer on precisely how many people will be involved. That will be known only when we complete the review for 1977–78.

Mr. Clark: Would not the Minister agree that previous cut-backs had a significant effect on the total unemployed? There is great anxiety and apprehension among workpeople engaged in defence industries about what is in store for them. Can the Minister confirm what the Chancellor of the Exchequer let slip yesterday in an aside to the hon. Member for Bolsover (Mr. Skinner) that the trade unions concerned had made representations to him expressing considerable fears about the future?

Dr. Gilbert: The hon. Member is quite right. My right hon. Friend and I have received representations from the trade union side of the defence contracting industries about what might be in store for them.

British Defences

Mr. Jessel: asked the Secretary of State for Defence if he is satisfied with British defences.

Mr. Mulley: I have no doubt that the Government's policy of concentrating our defence resources on the North Atlantic Alliance provides the best guarantee of our continued security. I am satisfied that we are continuing to make an effective military contribution to the collective security of the Alliance in accordance with the priorities established by the defence review.

Mr. Jessel: Is the Secretary of State aware that his satisfaction is not shared? Has he seen the literature put out by his Department saying that the vast military resources of the Warsaw Pact countries continue to pose a substantial threat to our security? When will he show himself to be alive to that threat?

Mr. Mulley: The fact that my Department is making this fact known shows that we are alive to the threat. However, we do not consider, and have not considered for the past 20-odd years, that this is a threat which we can contain by ourselves.

Mr. George Rodgers: Does my right hon. Friend agree that in present


economic circumstances the retention by the United Kingdom of an independent nuclear deterrent is an expensive absurdity and that it would be possible to make cuts in public expenditure in this area without dramatically affecting employment?

Mr. Mulley: I do not think that the nuclear deterrent and its contribution to the total forces of the Alliance is valueless. Also, if we disposed of it I do not think that the result would be entirely painless in terms of employment, despite what my hon. Friend suggests.

Mr. Luce: Will the Secretary of State make quite plain whether he endorses the views of his predecessor, given to me in a reply in July, when he said that to accept the proposals of the Tribune Group to cut defence expenditure still further would be at best neutrality and at worst surrender?

Mr. Mulley: I hope that I shall not be expected to confirm every answer given by my predecessor over two and a half years. But certainly, if the hon. Member has in mind the very large sums sometimes bandied about, I agree that to reach that target would greatly reduce our defence capability.

Expenditure

Mr. Ioan Evans: asked the Secretary of State for Defence what representations he has received regarding proposed cuts in defence expenditure.

Mr. Mulley: I have received a number of representations from various quarters, some protesting about cuts already announced, some in favour of further cuts in defence expenditure and others expressing anxiety about the effect which these cuts will have on employment prospects.

Mr. Evans: Will my right hon. Friend resist demands from the Tory Party calling for massive cuts in public expenditure but at the same time urging massive increases in defence expenditure? It is an immoral stance to demand greater expenditure on the Army, Navy and Air Force while calling for cuts in pensions and benefits to the disabled and sick.

Mr. Mulley: I have already made it clear that it is a little inconsistent to require additional expenditure on par-

ticular items and at the same time to beat the drum about total public expenditure. However, I have received many representations from colleagues on this side of the House and from trade unions strongly opposing the implementation of the cuts already announced.

Mr. Kershaw: No doubt the Secretary of State privately shares our concern about the north and south flanks of NATO. Will he do all he can to see that the deficiencies caused there are remedied?

Mr. Mulley: Of course I would like to see a strengthening of the flanks, but through the contribution we make to the ACE mobile force and the reserve RAF and naval contingents which we make available, we are playing our part, and it would be wrong to think that we can provide additional forces on either of these flanks.

Mr. Goodhart: asked the Secretary of State for Defence whether he will make a statement about the implementation of defence cuts.

Mr. George Rodgers: asked the Secretary of State for Defence if he can now define the areas in which the proposed £100 million cuts in defence spending will take place.

Mr. Wall: asked the Secretary of State for Defence what will be the effect of the latest round of cuts in appropriations for defence.

Mr. Mulley: I have nothing further to add to the answer given by my predecessor to the hon. Member for Harrogate (Mr. Banks) on 29th July 1976.

Mr. Goodhart: Does the Secretary of State agree with the statement by Field-Marshal Sir Michael Carver, when he was Chief of the Defence Staff last year, that we are down to absolute bedrock on defence cuts? If he does not agree, why not?

Mr. Mulley: I agree that it would be difficult to make further cuts without reconsidering some of the commitments involved. However, as my hon. Friend the Minister of State said, the £100 million cuts involved will be made. We are having a detailed assessment now of


the rephasing of the works and equipment programmes which will not directly affect the level of our defence forces.

Mr. Rodgers: Will my right hon. Friend comment on the Chancellor of the Exchequer's remarks about pressure from the trade unions concerning defence contracts and cut-backs? Will he advise whether similar protests have been made by trade unions representing the public sector? What has been the response in that area?

Mr. Mulley: I think that some of the representations we have received about defence cuts come from trade unions engaged in the public sector, because a number of cuts will involve a reduction in both the non-industrial and the industrial Civil Service as well as having an indirect effect on employment outside.

Mr. Wall: Is it not a fact that the Government's White Paper was designed to give stability to the forces for the next decade and that since then there have been four major cuts in defence expenditure? What has been the effect of the last two cuts, and how will they be implemented?

Mr. Mulley: We would all like stability in this uncertain world, but I fear that no one in this nation can at present be very secure for very long because of the serious economic situation. That situation is the culmination of a very long period of industrial stagnation. If I were a Conservative Member, I would get no satisfaction from the present situation. On the contrary, I would have hoped that the Conservatives would assist the nation to overcome the difficulties which are a challenge to the whole nation.

Mr. Clemitson: Which would produce a greater loss of jobs, a £100 million cut in defence expenditure or an equivalent cut in, say, the National Health Service or education?

Mr. Mulley: It would depend upon the salary levels. All the cuts in defence represent jobs, as they represent jobs in other services. I do not think there is any way of getting round that fact. In some cases of cuts in planned expenditure, jobs are not yet at risk.

Mr. Kilfedder: The right hon. Gentleman's predecessor is now Secretary of

State for Northern Ireland. Will the right hon. Gentleman consult his predecessor about the closure of defence establishments in Northern Ireland? That is making thousands unemployed in the Province, which already has the highest unemployment rate since the last war. Will he reverse that decision?

Mr. Mulley: I shall consult my right hon. Friend, but the facts of life are that we cannot reduce defence expenditure without in many cases causing either redundancies or the loss of job opportunities.

Mr. Ian Gilmour: I sympathise with the right hon. Gentleman in not being allowed to speak at his own party conference. Will he take advantage of this considerably more democratic and pro-western assembly to repudiate the defence aspects of the totally absurd 1976 Labour programme?

Mr. Mulley: The right hon. Gentle. man is misinformed. I addressed the party conference, but in order to demonstrate my versatility I spoke about the National Health Service and child benefits.

Naval Building Programme

Mr. Teddy Taylor: asked the Secretary of State for Defence if he will make a statement on the naval building programme.

The Under-Secretary of State for the Royal Navy (Mr. A. E. P. Duffy): The naval shipbuilding programme is proceeding satisfactorily.

Mr. Taylor: Is the hon. Gentleman aware of the concern felt in the Yarrow yard in Glasgow that nationalisation in the shipbuilding industry might result in a change in the present arrangements, whereby the Government concentrate naval shipbuilding in Vosper's, Vickers and Yarrow? Will he give an assurance that after nationalisation the policy of his Department of concentrating naval shipbuilding in these three yards will continue?

Mr. Duffy: Yarrow is at the moment building six frigates for the Royal Navy and it is expected that it will be invited to tender in the future for similar vessels. It has also been chosen as the second builder for glass reinforced plastic.


Neither of these will be affected by the nationalisation Bill which is now before Parliament.

Mr. Taylor: That was not the question.

Mr. James Johnson: Is my hon. Friend aware that the deepest anxiety is felt by all fishermen because of poaching by alien vessels off Scotland and elsewhere? What plans does he have for enlarging the fishery protection fleet? We shall need these boats when we extend our fishing limits as every other nation is doing at the moment.

Mr. Duffy: That is a slightly different question. But the Island class, which is under construction, is designed for this purpose and it will go into service next year with the four Nimrod aircraft which also will be available. Any further tasks which need to be undertaken will be provided for by existing resources.

Mr. Stephen Ross: Is the Minister aware of the concern of my constituents about the problems of Vosper-Thorny-croft, which is now short of orders in naval shipbuilding? There is concern that the nationalisation of shipbuilding will mean that in future naval shipbuilding will be concentrated in the North and in Scotland. Will the hon. Gentleman give an assurance that Vosper's will get its fair share in the future?

Mr. Duffy: Yes, I will give that assurance. Vosper-Thorneycroft was awarded the Type 42 destroyer contract earlier this year and it has tendered for the next Type 42 destroyer, on which no decision has yet been made. The nationalisation Bill at present before Parliament will not alter the situation.

INDIA

Mr. Marten: asked the Prime Minister if he has any plans to visit India.

The Prime Minister (Mr. James Callaghan): I have at present no plans to do so.

Mr. Marten: Since India is the largest country in the Commonwealth and is of immense importance, will the right hon. Gentleman explain why there has been no visit to that country by a leader of the Labour Party, I think, for the last quarter of a century? Will the Prime Minister

follow the example of my right hon. Friend the Leader of the Opposition, who clearly recognises the importance of India's rôle, particularly in the Commonwealth and particularly of its influence on today's world problems?

The Prime Minister: I agree that no Prime Minister from this country has visited India for some years, but let me remind the hon. Gentleman that my right hon. Friend the Lord President has just returned from a very successful visit and he has given me an account of his discussions with Mrs. Gandhi and other Ministers there which I think have helped to strengthen the tics between us. However, I would certainly consider such a visit if it is possible to fit it into the programme.

Mr. Robert Hughes: Has my right hon. Friend had any reports from Hans Janichek, Secretary of Socialist International, about the continuing detention of George Fernandes, the leader of the Socialist Party of India? Grave disquiet is being felt about the conditions of his detention.

The Prime Minister: A number of representations have been made about Mr. Fernandes. The Indian Government are aware that we are concerned about the proceedings being taken there. I trust that that action will result in his receiving a fair trial—I am sure that it will. I trust that in the end justice will prevail.

Mr. Gow: What lessons did the Lord President bring back from India about the freedom of the Press and the freedom of journalists to write freely in it?

The Prime Minister: That might be an interesting question to put down to my right hon. Friend. I am sure that he will be glad to answer it. I think that everybody who is not an enemy of India will welcome the fact that restrictions on the Press were lifted, I believe towards the end of September. I am sure that that will be welcomed by everybody who has connections with that country.

PRIME MINISTER (ENGAGEMENTS)

Mr. Corbett: asked the Prime Minister if he will list his public engagements for 12th October.

The Prime Minister: I shall be meeting Mr. Nguza, the Foreign Minister of Zaire, and this evening I shall be holding a reception in honour of the British Team at the 1976 Olympiad for the Disabled. In addition, I shall be holding meetings with ministerial colleagues and others.

Mr. Corbett: Will my right hon. Friend say whether he has been able to report to the Cabinet yet about his consultations with Chancellor Schmidt of West Germany? Is he aware that we Labour Members congratulate the Chancellor on his recent election success? He is on record as saying that the pound is grossly under-valued. Will the Prime Minister make a statement to the House on that conversation?

The Prime Minister: I have not so far made such a report. I congratulated Chancellor Schmidt on the success of his Government in the elections, and I am sure that the House will join with me in that. Our discussions covered a very wide range. They were without officials and went on for three and a half hours. We discussed a number of very important topics concerning not only such matters as East-West relations, but questions affecting the world economy and the interdependence of world trade. I found these discussions to be of very great value in enabling each of us to influence the other's attitudes.

Mr. Gordon Wilson: Will the Prime Minister be putting into his diary for this evening a possible meeting with representatives of the offshore module and platform construction yards, who are presently facing redundancies, in view of the emergency situation and the fact that they have travelled all the way from Scotland to discuss these matters with Ministers and those Members who are interested?

The Prime Minister: I am afraid that I cannot add now to my engagements for today. I had no previous notification of this proposal. I am sure that Members representing certain constituencies, and any Ministers that the representatives have arranged to see, will be glad to hear their representations.

Mr. Rifkind: Will the Prime Minister seek to emulate Herr Schmidt at the next election by ending up with fewer seats

than the Opposition? As regards today's announcement that the right hon. Gentleman is to take the Chancellor of the Exchequer with him to his meeting with President Giscard d'Estaing in France next month, is he satisfied that the condition of the economy will allow both the First Lord of the Treasury and the Chancellor to be out of the country at the same time?

The Prime Minister: I must remind the Opposition, who are in danger of forgetting this, that at present the Labour Party has 36 more seats in the House than the Conservative Party—[Hors. MEMBERS: "SO what?"] The conclusion to be drawn is that we sit on the Government side and the Opposition sit opposite us.
The next election may well be a very long way off. Provided that the Government do not lose their nerve, as our predecessors did in 1972–73 on such matters as the money supply, we have a very good chance of coming through the next election with perhaps even a larger majority.

Mrs. Thatcher: Do I take it that the result of Chancellor Schmidt's visit to this country was that the Prime Minister learnt from him that if the Government hold an election early they may lose a large number of seats and will have to be saved by the Liberal Party?

The Prime Minister: The German elections, unlike ours, are held at fixed intervals. Although it is possible to hold elections early, on this occasion the election was held at the appropriate time as laid down by statute. As regards depending upon the Liberals, I have made it clear many, many times that as long as I can manage even a modest degree of support from my colleagues, the Labour Party will continue as the Government of this country and I shall be happy to lead it.

Mr. Pardoe: The Prime Minister will know that the Leader of the Opposition was a member of the Government who did their damnedest to get the Liberal Party to bail them out. In the course of his conversations with Herr Schmidt, did the right hon. Gentleman discover exactly what the German Chancellor meant by the word "under-valued" in the context of the British economy?


Would the right hon. Gentleman like to amplify, having taken his tutorial from Herr Schmidt, exactly what an undervalued currency means?

The Prime Minister: I did not exactly cross-examine the Chancellor on this matter, but I think that he had in mind the competitive nature of British industry in the export market. Our goods can be sold at a much higher rate of exchange than sterling is commanding in the foreign exchange market. That is not a strange phenomenon. Indeed, I believe it was referred to in yesterday's debate. I am aware of some Midland manufacturers who are valuing their exports at a much higher rate than the short-term foreign exchange market. Although I did not cross-examine the Chancellor, I imagine that it was that to which he was referring.

CBI AND TUC

Mr. Wyn Roberts: asked the Prime Minister when he last met the CBI and the TUC.

Mr. Michael Latham: asked the Prime Minister when he last met the TUC.

Mr. Robinson: asked the Prime Minister when he last met the CBI.

The Prime Minister: I am frequently in touch with leaders of the TUC and the CBI, both at the National Economic Development Council and on other occasions. Further meetings will be arranged as necessary.

Mr. Roberts: At the July meeting of the NEDC the Prime Minister emphasised the importance of profitability for industrial investment, job creation and job preservation. How does he honestly view the prospects for profitability in industry now when £1,700 million is to be taken out of the system by the increase in the minimum lending rate and employers' national insurance contributions?

The Prime Minister: Obviously the additional national insurance contributions will lower profitability. However, it is interesting and reassuring that the liquidity position of companies has been building up during the past few months. Companies now have more liquid resources from which to finance new investment, or whatever it is they wish

to undertake, than they had some time ago, and that is to the good.
I am not in the forecasting business—anyway, I hear too many forecasters. I take the view that profitability under the relaxed Price Code—it is not entirely removed—should continue to build up. I think that that will to some extent offset the increase in the minimum lending rate, which was bound to have an adverse effect yesterday. The effect must depend upon how long that rate continues.

Mr. Robinson: When my right hon. Friend next meets the CBI, will he draw to its attention, and to the attention of Opposition Members, that even before the regrettable increase in lending rates and, indeed, when lending rates were much lower, industry was drawing less than 40 per cent. of the facilities available to it from the banks? As my right hon. Friend has said, it is in current gross surplus from its own cash flow. Nevertheless investment is currently 12 per cent. below what it was last year. While we welcome the CBI's intentions for next year, we see no reason for its not getting on the with the job now.

The Prime Minister: The most important thing still for the Government to stick at is overcoming inflation. That, I think, will undoubtedly improve the desire of companies to invest, just as it will improve the objective of securing more jobs. According to the latest views and proposals, I understand that companies will invest about 15 per cent. to 20 per cent. more next year. [Interruption.] Certain Opposition Members are now becoming sedentary prophets. None of us knows what are the intentions, but when we work out the arithmetic it does not work out in the way that some hon. Members suggest.
It would have been valuable if some more industries had taken advantage, as has the non-ferrous industry and the machine tool industry, of our accelerated project scheme, encouraging companies to invest now against the upturn in demand. Undoubtedly that has had an important effect. For a relatively small expenditure of public money we have been able to attract a great deal of extra investment, and that has been accelerated. I hope that others will follow that lead.

Mr. Latham: Will the Prime Minister be stressing to the TUC that he remains


unalterably opposed to the Labour Party conference resolution about the nationalisation of the banks, not just because it is an electoral albatross, but because it is bad for Britain?

The Prime Minister: Perhaps the hon. Gentleman will be good enough to leave relations between myself and my party to me. If he were to offer to join, I should send him a membership form, but I doubt whether we should let him come in.
As regards the future of the banking system, my right hon. Friend the Member for Huyton (Sir H. Wilson) can be trusted to make a detailed examination of all the matters involved. I am glad that his appointment has been so well received, except among Opposition Members. When the examination has been completed, we shall be able to see what are the functions of the banks, how they perform their parts and to what extent it is true that the failure of British industry to invest is related to their policies. For myself, I am not convinced that that is so, as I have said on other occasions.

Mr. Wrigglesworth: Does my right hon. Friend agree that one of the most complex and difficult problems facing the Government in the forthcoming year will be putting some bones on an orderly return to free collective bargaining? What plans do the Government have for discussing this with the TUC so that it can help to sustain the present pay policy and restore the confidence in the pound, which is so necessary now?

The Prime Minister: I said at the end of last night's debate, though I am not sure whether it was heard above the hubbub from the Opposition, that it is necessary to have a policy for prices and incomes next year. We are about to begin discussions with the TUC at the appropriate time and we shall also be discussing the matter with the employers in due course. The first thing to find out is whether it is possible to get an agreement on that approach. I have read with care the speeches made at the TUC conference and I am not without hope in this matter. The TUC leaders understand the situation perfectly well and they know that there cannot be a complete return to free collective bargaining.

Mrs. Thatcher: Is the right hon. Gentleman aware that my hon. Friend the Member for Melton (Mr. Latham) was asking him to answer to this House on where he stands on banking and insurance nationalisation? Where does he stand?

The Prime Minister: I answered to the House last night, and we got a majority of 13.

RHODESIA

The Secretary of State for Foreign and Commonwealth Affairs (Mr. Anthony Crosland): I will, with permission, make a statement on Rhodesia.
On 22nd March my right hon. Friend, now Prime Minister, told the House that no settlement in Rhodesia was possible until all the parties concerned accepted the principle of majority rule, to be attained within 18 months to two years; and that only when that principle had been accepted would Her Majesty's Government be prepared to play a constructive part in any negotiations.
During the summer months, a number of ministerial visits to Southern Africa took place, both British and American. These included two by my hon. Friend the Minister of State, and in particular a prolonged and crucial tour by Dr. Kissinger to whose forceful diplomacy I now pay tribute. The Prime Minister and I saw Dr. Kissinger both before and after his shuttle, and I have been in almost continuous touch with him during the whole of this period.
On 24th September, Mr. Smith announced that his regime now accepted the principle of majority rule within two years. This long-awaited development demonstrated at last a realistic understanding of the true situation in Southern Africa and has presented us with a real opportunity of achieving a rapid and peaceful transfer of power in Rhodesia.
The next step was to organise a meeting without delay between the Smith regime and the African nationalists to discuss the formation of an interim Government. Accordingly I announced on 29th September that I would convene an early conference for this purpose, and that the chairman would be Mr. Ivor Richard, QC, acting as the Government's special


representative. Last Friday, as the House will be aware, I announced my intention that the conference would assemble in Geneva on 21st October, with a view to a formal opening on 25th October.
I have decided to invite to this conterence, on behalf of the nationalist interests, Mr. Robert Mugabe, Bishop Muzorewa and Mr. Joshua Nkomo. I am asking them to nominate additional delegates. I have invited Mr. Smith to nominate representatives of the Rhodesia Front. These invitations were despatched this morning.
There have, Mr. Speaker, been many statements by many people in the last few days about the forthcoming conference. I hope that the House will not press me to comment on these statements, or on the negotiating positions of the parties to the conference. It would not be helpful to become embroiled, before the conference has opened, in a public discussion of issues which can only be decided at the conference itself.
I am, of course, most anxious to do everything within my power to ensure a successful outcome to the conference. I have had most useful exchanges of views in New York and in London with a number of African Foreign Ministers in the last few days and I have sent my Special Adviser on African Affairs, Mr. Dennis Grennan, to Lusaka, to assist the process of liaison during the run-up to the conference. The prize within our grasp is a free, prosperous and multi-racial Zimbabwe. Her Majesty's Government are determined to do all in their power to bring a peace to Zimbabwe which is firmly rooted in majority rule and thus in equality and social justice.

Mr. Maudling: I thank the Foreign Secretary for making a statement and I am sure that the whole House will agree that we wish to see a successful conference, but there are a number of points on which I must ask for further information.
Is Mr. Smith's account of the proposals put to him by Dr. Kissinger—the only account we have available at the moment—substantially correct? If not, in what way is it wrong? Were the proposals discussed with and agreed by the British Government in advance? Were they dis-

cussed with and agreed by the African Presidents in advance?
The Foreign Secretary said in his statement:
all the parties concerned accepted the principle of majority rule, to be attained within 18 months to two years".
Does this mean that no one is pressing for an immediate transfer of power?
I appreciate the reluctance of the Foreign Secretary to say more, but the House is entitled to know the answers to these questions. After all, we are still responsible for Rhodesia.

Mr. Crosland: I am grateful to the right hon. Gentleman for his opening remarks. I am sure that the whole House wishes to see a successful outcome to the conference.
Mr. Smith's proposals regarding the structure and functions of an interim Government reflect ideas previously discussed between the Americans and ourselves and the African Presidents. They constitute, in our view, a useful basis for further discussion.
As I said in New York, we have no intention of pre-determining these matters in advance. Our concern must be to ensure that whatever is agreed between the parties is consistent with the Prime Minister's statement of 22nd March, endorsed at that time by everyone in this House. We want a rapid and orderly transition of power to the majority. Mr. Smith has accepted the need for this, and that is the foundation on which we must build.

Mr. Maudling: If no one is committed in advance, to what extent is Mr. Smith committed in advance?

Mr. Crosland: That is a question which ought to be addressed to Mr. Smith. I have put the position of the Government, the African Presidents and the United States quite clearly. As far as the United States is concerned, I would add only what Dr. Kissinger said at a Press conference on 22nd September—that nothing had yet been settled regarding the composition of an interim Government or the allocation of ministries and that these were matters which required negotiation.

Mr. David Steel: Should not the Foreign Secretary be stressing the importance of the basic agreement on transition towards majority rule within two years? Are not all other views and reservations and the jockeying for position prior to the conference, which is wholly understandable, completely subordinate to that end and that agreement?
There has been some criticism from the Foreign Secretary's hon. Friends and the African nationalists about the appointment of Mr. Richard as chairman of the conference. Will the right hon. Gentleman confirm that Mr. Richard's appointment to the United Nations was a political one, that he enjoys the closest confidence of the Government and that the fact that he is not a Minister is irrelevant? Will he also confirm that once an interim Government has been set up there will have to follow the normal kind of constitutional conference, held by Great Britain, to form a proper independence constitution?

Mr. Crosland: I wholly agree with the hon. Gentleman's first question. The crux is to get the conference and the interim Government. At a time when most disputes are increasingly settled by force and violence, the conference at least offers us the hope that we may get a peaceful settlement.
I confirm that Mr. Richard's appointment was a political one. He holds a special position because of his connection with the United Nations and I chose him because of his personal suitability for this task. The appointment has been greatly welcomed by most people.
I confirm what the hon. Gentleman said in his third question, though that will be a separate stage. There will have to be a constitutional conference followed by legislation in this House confirming the independence of Zimbabwe, which will by then have majority rule.

Mr. Arthur Bottomley: Is my right hon. Friend aware that earlier this year I suggested to my right hon. Friend the Prime Minister that it would be better to leave the settlement of the Rhodesian problem to the Southern African Presidents and Mr. Vorster? I still believe that that is the best course to follow. What has led my right hon. Friend and Dr. Kissinger to believe that Mr. Smith will be able to keep his word on this

occasion? To what extent will Dr. Kissinger be involved in the negotiations, if they take place? What will be the cost to the British taxpayer of bailing out those who rebelled against the Crown?

Mr. Crosland: First, what led us to think that this course of action, this initiative, was the right one was a large number of separate discussions with all the parties concerned in Africa. Nobody can guarantee that it is the right initiative. Nevertheless, on the best advice that we have had from all parties, this seems to offer the best prospect of success.
Secondly, will Dr. Kissinger take part in the talks? No, he will not. The Kissinger role over the last six months, for a number of obvious reasons, has been critical and crucial. But, from now on, this country will convene and chair the conference.
Thirdly, the cost to the British taxpayer is not the cost, if there is such a cost in the end, of bailing out white Rhodesians. This is part of what I hope will be an international operation, first, to bring development to the newly independent Rhodesia; secondly, to increase educational and technical opportunities for African development; and, thirdly, to encourage white Rhodesians who are prepared to play their part in a multi-racial Zimbabwe to stay there and play the part that we want them to play.

Mr. Powell: Does the right hon. Gentleman agree that, by accepting a position of responsibility without power, the United Kingdom is incurring the almost certain prospect of humiliation without the slightest offsetting advantage to any of the parties involved?

Mr. Crosland: No, Sir. I have to accept the basic fact that in my view, and I think the view of a huge majority in this House, Britain has a moral and constitutional responsibility for a final outcome in Rhodesia. That is not a responsibility which this Government or nation would wish to abrogate.

Mr. Alexander W. Lyon: Why were black nationalists not consulted about the detailed terms of the offer to Mr. Smith before it was put to him? Are we going to make the same mistake again by not inviting Mr. Sitole to the conference when he still represents a substantial slice of ZANU opinion, and has shown it?

Mr. Crosland: There was a very high degree of consultation extending over many months with all representatives of black nationalist opinion. We think that we have got the best outcome that we can get from that consultation.
Regarding representation at Geneva, as I said in my statement, it was after consultations with the African Presidents that I decided to invite Mr. Mugabe, Bishop Muzorewa and Mr. Nkomo. Subject to further consultation, I should be prepared to consider other invitations if they would increase the chances of success at the conference.

Mr. Amery: Are we right in understanding that Mr. Smith's acceptance of majority rule within two years was part of a package deal based on a document which, as he expressed it, was agreed between him and Dr. Kissinger and had been previously agreed with the British Government? Will the right hon. Gentleman confirm that that is the position? Is he aware that the honour of the British Government is at stake?

Mr. Crosland: On this point, I repeat that Mr. Smith's proposals regarding the structure and functions of the interim Government reflect ideas previously discussed between the Americans, ourselves and the African Presidents. As I said in New York, they constitute a useful basis for further discussions.

Mr. Amery: On a point of order, Mr. Speaker. I think that the right hon. Gentleman is in danger of misleading the House, because he said "Mr. Smith's proposals". I understood that this was a document and that Mr. Smith was quoting something said by Dr. Kissinger.

Mr. Crosland: I referred to Mr. Smith's proposals, because it was Mr. Smith's proposals which opened up the possibility of a completely new situation. I cannot say in detail what Mr. Smith and Dr. Kissinger discussed. The right hon. Gentleman referred to the honour of the British Government. My hon. Friend the Minister of State visited and had talks with Mr. Smith. and those talks were conducted precisely on the basis which I have just explained to the House.

Mr. Maudling: We really must get this straight. Was Mr. Smith speaking the truth when he said that certain proposals

which he described were put to him by Dr. Kissinger? Was that done with the approval of Her Majesty's Government? It is a simple question which requires a simple answer. Why does not the Foreign Secretary answer the question?

Mr. Crosland: I will answer on behalf of Her Majesty's Government, not on behalf of other Governments. On behalf of Her Majesty's Government, I repeat that when the Minister of State spoke to Mr. Smith he spoke precisely on the understanding and within the framework of what I have already said to the House. Questions on behalf of other Governments must be answered by other Governments.

Mr. Hooley: Does my right hon. Friend agree that the success of what happens at Geneva will depend on the situation on the ground in Zimbabwe? Is it not intolerable that the African nationalists should be expected to negotiate while the white racist regime continues to control the Armed Forces in Rhodesia? Would it not be advantageous to appoint a commander of those forces who is loyal to the Crown?

Mr. Crosland: No, it would not be advantageous. The fact is that all the parties concerned must negotiate on the position as it has now been reached. I believe that they will now so negotiate and that those invited will attend the conference. The essential thing is to accept that finally we have an opportunity for success and that the more preconditions which are laid down before the conference, the less chance there is of success.

Mr. Goodhew: Is the right hon. Gentleman aware that when I saw Mr. Ian Smith, as recently as last Saturday, he was still confident that there was a package deal put to him by Dr. Kissinger which the British Government would support but that he was becoming anxious about the noises now being made about negotiating as if the package deal had never existed?
Is the right hon. Gentleman also aware that in 1961, when Sir Edgar Whitehead produced a constitution giving more political advance to the black Rhodesians, Mr. Joshua Nkomo, who had accepted it, went to the Organisation of African Unity and was sent back to reject it and to demand "one man, one vote" immediately? Is the right hon. Gentleman going


to stand by and allow leaders from other black African countries to talk him out of the agreement and thus dishonour Great Britain?

Mr. Crosland: Anybody who thinks that there is dishonour to this country in trying to achieve what most people a year ago would have thought was absolutely out of the question—a peaceful transfer of power in Rhodesia—is not reflecting in any way the opinion of people in this country.
I have read in the greatest detail what my hon. Friend the Minister of State said to Mr. Smith, whom he saw only a few days ago. What he said to Mr. Smith was clear. My hon. Friend was talking not in terms of a package deal but of a series of proposals which in his view would offer a useful basis for discussions. That is precisely the position.

Mr. Kinnock: Does my right hon. Friend accept that I regret that there appears to be some preconditions which must be established if we are to take out guarantees against the Rhodesian situation eventually descending into bloody chaos? They include that we cannot trust the Smith regime with authority over law and order and arms in Rhodesia and accept the prophecies of Mr. Gibbs of the Rhodesia Party, the Conservative Party, and Mr. Bashford of the Centre Party that the interim Government could be overthrown by a recalcitrant Smith regime in the event of things not going the way that they want them to go?

Mr. Crosland: No. I have been pressed for preconditions by both sides in the discussions. I have no intention of accepting the idea of preconditions. I am absolutely convinced that the more people on either side press for preconditions to be laid down prior to the conference, the less chance there is of the conference succeeding.

Mr. Blaker: Does the Foreign Secretary recall that on the evening of 24th September, after Mr. Smith's speech, his Department put out a statement that said that Her Majesty's Government noted with satisfaction the acceptance by Mr. Smith of the proposals put to him by Dr. Kissinger? Did the right hon. Gentleman approve that statement?

Mr. Crosland: The position is precisely as I have stated it. [Hors. MEMBERS: "Answer."] It is precisely as I have stated it and precisely as my hon. Friend the Minister of State put it to Mr. Smith—namely, that the proposals that Mr. Smith put forward when he made his statement were a useful basis for discussion. They will not be the only proposals before the conference, I have no doubt, but they will be tabled undoubtedly by Mr. Smith to the conference. Other propopsals will be tabled and they will form, as we have told Mr. Smith, a useful basis of discussion.

Mr. Whitehead: As my right hon. Friend has said that he has issued invitations only to Mr. Smith and the Rhodesia Front as representatives of the minority community in Rhodesia, what steps will be taken to ascertain the opinions of other members of the white community in that country who may be more amenable to the kind of multi-racial State to which we all look forward in Zimbabwe than is the hard-line caucus of the Rhodesia Front?

Mr. Crosland: My hon. Friend the Minister of State talked to representatives of the white minority groups in Rhodesia and I considered very seriously the question whether to invite them to be represented at the Geneva Conference. Mr. Smith himself has made it clear that he would prefer the white Rhodesian delegates all to come from the Rhodesia Front, and there was no pressure in the opposite direction from African leaders. I therefore decided that as these parties were not represented in the Rhodesian Parliament, the sensible thing from every point of view was to have the representation solely from the Rhodesia Front.

Mr. Cormack: Is the Secretary of State aware that his evasiveness this afternoon could go far to damage the prospects of this conference, in which all of us believe? Will he state categorically whether Dr. Kissinger took a set of proposals to Mr. Smith, whether he saw those proposals, and whether they were in writing, or whether Mr. Smith himself, of his own volition, initiated the proposals which were then broadcast to his nation?

Mr. Crosland: I can state categorically only what the British Government have


said to Mr. Smith, and I have stated it categorically. I do not like to answer categorically for discussions between two leaders of other Governments. What my hon. Friend said to Mr. Smith—I repeat it categorically—was not that proposals which had been discussed with the Americans and African Presidents had been agreed but that those proposals constituted a useful basis for discussion. As far as the British Government are concerned, no set of proposals had been finally agreed as a basis for a settlement.

Mr. Jay: To avoid misunderstandings, will my right hon. Friend say whether the Kissinger Plan is recorded in some precise document or is a purely verbal one? If it is written, can it be published?

Mr. Crosland: No, Sir, it is not recorded in a precise document. The position is that in the course of this whole joint initiative, lasting over a period of months, a number of planning papers were produced on both sides. No definitive document was produced which constituted the offer which had the agreement and the endorsement of the British Government.

Mr. Hastings: In the event of an agreement between the parties, for which we must all hope, are the British Government prepared, either with the Americans or independently of them, during the transitional period to guarantee the integrity of Rhodesia's frontiers against Communist-inspired terrorism, and, if so, how?

Mr. Crosland: What further action the British Government will be prepared to take will depend on the outcome of the talks on the formation of the interim Government. I should prefer, as I think would most hon. Members, to answer questions about future British actions and responsibility when we see the outcome of the Geneva Conference.

Mr. John Mendelson: Will the Secretary of State accept that there is very widespread support for the initiative he has taken in this matter? Criticism from abroad now seems to be echoed by a very considerable number of hon. Members who for years have been pressing the Government to take such an initiative—and that comes very strangely from hon.

Members on this occasion, when the initiative has been taken.
Will my right hon. Friend also accept that while there will be a great deal of sympathy for his desire not to go into detail today, a number of people who have a great deal of information from the circles of those who have been fighting for freedom in their own country, Rhodesia, for so many years now, feel that those people must have the chance to live freely during the two-year or 18-month period as citiziens there? Exiles must he able to return. My right hon. Friend must indicate even today that they can have the opportunity under the interim Government to exercise their democratic rights as citizens. That is what we of the Labour Party insisted upon when Sir Alec Douglas-Home was going on a conciliation mission, and we must insist on the same thing with my hon. Friend, as he represents us in the present negotiations.

Mr. Crosland: I am obliged for my hon. Friend's opening remarks, which I think are correct and true. As regards what may or may not come out of the Geneva Conference, I prefer to say nothing at present.

Mrs. Thatcher: May I ask the Foreign Secretary again about the proposals put by Dr. Kissinger to Mr. Smith? It seems to me, from what the right hon. Gentleman has said, that he is now saying that the Foreign Office was in error when it put out an official statement saying that Mr. Smith had accepted proposals put to him by Dr. Kissinger and that those proposals represented an elaboration of the plan originally advanced by the Prime Minister. Is that a correct statement, or was the right hon. Gentleman's office at fault?

Mr. Crosland: No, Sir, that was a correct statement, because all the proposals made in the course of this series of discussions, with not only Mr. Smith but the Black African Presidents, were an enlargement of the Prime Minister's own statement of 22nd March. I am not authorised, obviously, to speak in detail on Dr. Kissinger's behalf. I repeat, however, what he said at a Press conference at the end of September in New York. I have quoted it earlier. He said that nothing had yet been settled regarding


the composition of an interim Government or the allocation of Ministers. This is a matter which requires negotiation.

Mrs. Thatcher: What were the proposals that were accepted?

Mr. Crosland: The proposals that were accepted were what Mr. Smith set out in his six proposals. Dr. Kissinger has made it clear, and I have now made it clear, that these are in our view a useful basis of discussion. [HON. MEMBERS: "Oh."] They are a useful basis of discussion. I repeat the statement of Dr. Kissinger—that these are matters which require negotiation. But nevertheless they offer a useful basis for discussion.

Mr. Robert Hughes: Is there not something rather obnoxious about the Leader of the Opposition and her cohorts accepting the word of a traitor rather than the words of a Minister?
However, to return to the constitutional conference in Geneva, is it the Government's view that Mr. Ivor Richard should play simply a neutral rôle as chairman, or will he have something positive to say, of some positive effect, on matters such as the release of all detainees and the ending of all hangings in Rhodesia?

Mr. Crosland: No, Sir, I shall not say anything more on the latter part of my hon. Friend's question. On the former part, the ethics of the Leader of the Opposition are no business of mine. However, a very large number of questions that have come from the Opposition today have hardly been conducive to the successful outcome of the conference.

Mr. Aitken: Is the Foreign Secretary aware that his answers this afternoon give the impression that something fishy is taking place? Are we now to understand that nothing has been set down definitively in writing and that nothing has been signed, but that all we are talking about is a vague series of other people's proposals floating around between Mr. Smith and the African Governments? If that is the case, there could not be a worse basis for a serious conference and a serious agreement.

Mr. Crosland: There has been no final or definitive document put forward by Her Majesty's Government. What I have

made clear—and I now repeat it—is that a number of proposals have been discussed both with Mr. Smith and with the African Presidents reflecting the ideas that have followed from a discussion between the British and United States Governments and African Presidents. A number of proposals have been put forward, but none represents a definitive statement of what the British Government have guaranteed to anybody.

Mr. Fernyhough: Does my right hon. Friend recall that when Mr. Smith declared UDI we were told by Conservative Members that it was militarily impossible to intervene? Since we were not then prepared to take military action to deal with rebels against the Crown, why should we now agree that, in the event of the arrangements in Rhodesia not succeeding, we should guarantee by military methods the borders which the Conservatives were not prepared to defend when Mr. Smith declared UDI?

Mr. Crosland: I have not said this afternoon—and I wish to emphasise this point—that whatever comes out of the Geneva Conference the British Government would be prepared to give military guarantees to Rhodesia, whatever regime emerges there. We shall consider what help we can give at that stage. It seems to me highly unlikely that the House would support military guarantees.

Several hon. Members: rose—

Mr. Speaker: The House has now spent half an hour dealing with this matter. I shall allow two more contributions, and we must then move on.

Mr. Brittan: If proposals have been put to Mr. Smith and if those proposals have been accepted, as the Foreign Secretary ultimately admitted, how can the Government consider that they have behaved honourably if they now describe those proposals and their acceptance as no more than a basis for negotiation?

Mr. Crosland: It was made clear by Dr. Kissinger and by myself in New York that these matters were bound to be the subject of negotiation at the conference It has been made abundantly clear by both the British and United States Governments that that has been the case. When my hon. Friend the Minister of State saw Mr. Smith—and I emphasise


that I do not wish to speak on behalf of the heads of other regimés—Mr. Smith accepted perfectly well the fact that the discussion was bound to go beyond the proposals that had been put to him.

Mr. Faulds: Is the Foreign Secretary not somewhat surprised that the sole concern of the Opposition this afternoon seems to he to seek to protect Mr. Smith and not to give a damn about the Africans? May I ask my right hon. Friend specifically whether he will seek to ensure at the conference that Her Majesty's Government see to it that the military leaders responsible for the massacre of Africans, the so-called judges who have perverted justice, and the rebel politicians responsible for this tragedy are brought to justice and face the retribution that they deserve?

Mr. Crosland: It would have helped all concerned if a single member of the Opposition—I except from this criticism the right hon. Member for Chipping Barnet (Mr. Maudling)—had offered a single word of encouragement for the success of the conference, instead of deliberately trying to sow confusion and misunderstanding.

Several hon. Members: rose—

Mr. Speaker: Order. We cannot debate the matter now.

RHODESIA

Mr. Cormack: I beg to ask leave to move the Adjournment of the House, under Standing Order No. 9—and I apologise that I could not give you prior notice, Mr. Speaker—for the purpose of discussing a specific and important matter that should have urgent consideration; namely
the uncertainty surrounding the background to the Rhodesian situation and the forthcoming conference to be held in Geneva.
It is clear from what we have heard from the right hon. Gentleman the

Foreign Secretary this afternoon—and I wish to emphasise that the Opposition are just as anxious as anybody else to see a peaceful settlement of the dispute—that there is a most unfortunate element of uncertainty and equivocation emanating from the Foreign Office. Therefore, before this matter is discussed in Geneva, it is vital that it should be fully ventilated in this House and that we should have a full and unequivocal statement from the Foreign Secretary.

Mr. Speaker: The hon. Member for Staffordshire, South-West (Mr. Cormack) asks leave to move the Adjournment of the House for the purpose of discussing a specific and important matter that he thinks should have urgent consideration, namely
the uncertainty surrounding the background to the Rhodesian situation and the forthcoming conference to be held in Geneva.
As the House knows, under Standing Order No. 9 I am directed to take account of the several factors set out in the Order but to give no reason for my decision.
I have listened carefully to the representations made by the hon. Gentleman, but I have to rule that his submission does not fall within the provisions of the Standing Order. Therefore, I cannot submit his application to the House.

STATUTORY INSTRUMENTS, &c.

Mr. Speaker: To save time I will put the Question on the three motions relating to Statutory Instruments together.

Ordered,
That the Countervailing Duty Order 1976 (S.I., 1976, No. 1179) be referred to a Standing Committee on Statutory Instruments, &amp;c.
That the Roads (Speed Limit) Order (Northern Ireland) 1976 (S.R. &amp; 0. (NJ.), 1976, No. 182) be refered to a Standing Committee on Statutory Instruments, &amp;c.
That the draft Weights and Measures (Additional Metric Weight) Order 1976, be referred to a Standing Committee on Statutory Instruments, &amp;c.—[Mr. John Ellis.]

CHILDREN AND YOUNG PERSONS

4.6 p.m.

Mr. Robert Kilroy-Silk: I beg to move,
That leave be given to bring in a Bill to amend the law relating to children and young persons.
This Bill will make it illegal in future to send on remand schoolchildren of 14 to 16 years of age to prison service establishments. At present there is no legal requirement to commit schoolchildren in that age group to such establishments when they have been convicted and sentenced, yet in practice many thousands of schoolchildren are committed to penal service establishments on remand while awaiting sentence for conviction.
In 1975 over 5,000 boys were sent to penal service establishments, of whom over 2,500 were untried. In other words, those schoolchildren had not been convicted, still less sentenced, for any offence. In that same year nearly 400 girls were committed to penal service establishments, of whom nearly 200 were on remand, before they had even been tried for the offence with which they had been charged.
It seems a staggering situation that over 5,000 boys and nearly 400 girls are sent to prison every year on remand while awaiting conviction or sentence. It is even more incredible when we take into account the fact that a large proportion of such children are untried offenders.
The situation is even worse when we examine more closely the ultimate disposal of those schoolchildren in penal service establishments. Of the 5,000 boys sent to prison service establishments in 1975, over 2,000 were ultimately determined to have been not guilty of the offence charge or to have been guilty of an offence so trivial as to merit only a non-custodial sentence. Again, of the 400 girls incarcerated in penal establishments in that year, nearly 300 were given non-custodial sentences or were found to be not guilty.
Yet all of these had experienced the harrowing conditions of prison service establishments and, in many cases, of local adult prisons—very often for what,

by any stretch of the imagination, could not be regarded as other than a relatively trivial offence.
If we examine the kind of offences for which 14-year-old girls are incarcerated on remand in Holloway Prison we shall be surprised, not just by the triviality of the offences, but by the lack of justice and compassion of a judicial and welfare system that can dispose of young persons in such a callous and coldhearted manner. Even more significant in many ways is the fact that these children are not incarcerated in establishments for only a relatively short time. Many have spent months there.
Of those boys subsequently found not guilty one had spent up to four months in a prison service establishment and then, surprisingly, was eventually found not guilty. A total of 15 boys had spent a month in prison service establishments before being found not guilty and 27 had spent two weeks in such establishments. Of those who were given non-custodial sentences—who were found guilty and sentenced by the court but who were deemed to have committed an offence of such a relatively trivial nature as not to require imprisonment—one boy had spent up to six months in a prison service establishment, five had spent up to four months, 56 had spent up to two months and 209 had spent up to one month.
If we examine the figures for girls it can be seen that two girls eventually found not guilty had spent a month in Holloway Prison. Eleven other girls found not guilty had spent two weeks there. Of those given non-custodial sentences one had been three months in a penal service establishment and seven had been there two months while 27 had spent one month in such an establishment.
Yet under the system we operate they had served a prison sentence, in many cases in a local adult prison. We are not just talking about remand centres, which in any case are prisons, but of local prisons, too. For instance, on 30th April this year there were 17 boys between the ages of 14 and 16 in local adult prisons and 12 girls in Holloway Prison.
No one would suggest that it is right or proper that schoolchildren should be sent to prison service establishments. We cannot send them there once they have been found guilty of an offence but we


can send them there before they have been found guilty or, if they have been found guilty, they can be sent to such places before being sentenced to Borstal training, a detention centre or whatever. We would in no circumstances deem to treat adults in this fashion. Yet somehow or other we manage to have a different and much lower standard for schoolchildren, whom we dispose of callously, almost in a malicious fashion.
No one would argue that there are not trouble makers. I do not defend vandalism or juvenile violence. It exists and has to be dealt with. But no one could reasonably argue that it should be dealt with by sending young children, sometimes the most inadequate children, to prisons and prison service establishments. It happens for reasons of pure administrative convenience. These children are there because successive Governments have failed to provide the resources to build secure units in community homes. I am glad that my right hon. Friend the Secretary of State for Social Services is here today because the responsibility rests squarely upon his shoulders to take out of our prison service establishments those children who he and I would agree ought never to have been put there in the first place and ought not to be there now.
Unfortunately it is the Home Office that has to carry the can for these children being in such establishments. But the responsibility for getting them out lies squarely on my right hon. Friend. I admit that he and his predecessors have made some movement in this direction. The previous Home Secretary phased out the unruly certificate for girls of 14 and the previous Secretary of State for Social Services provided more resources for community homes. But that is not enough. Unless we take the dramatic action of saying that there shall not in future be the power, by unruly certificates or other means, to send schoolchildren to prison, they will continue to be sent there because no Government will be prepared to provide the resources for the secure units in a local authority community home.
We have to close this road. If it is closed I am certain that the Government will find a road that is more convenient and far more appropriate to the restitution aspect and to the welfare of these school children.

Question put and agreed to.

Bill ordered to be brought in by Mr. Robert Kilroy-Silk, Mr. Frank Hooley, Mr. Andrew F. Bennett, Miss Jo Richardson, Mr. Robin Corbett, Mr. J. W. Rooker and Mrs. René Short.

CHILDREN AND YOUNG PERSONS

Mr. Robert Kilroy-Silk: accordingly presented a Bill to amend the law relating to children and young persons: and the same was read the First time; and ordered to be read a Second time tomorrow and to be printed. [Bill 229.]

PARLIAMENTARY AND OTHER PENSIONS AND SALARIES BILL

Resolved,
That, in pursuance of the Parliament Act 1911, this House directs that the provisions of section 1(1) of that Act shall not apply to the Parliamentary and Other Pensions and Salaries Bill.—[Mr. John Ellis.]

HEALTH SERVICES BILL (ALLOCATION OF TIME)

Motion made, and Question,
That the Report [4th August] of the Business Committee be now considered.—[Mr. John Ellis.]

put forthwith, pursuant to Standing Order No. 43 (Business Committee), and agreed to.

Report considered accordingly.

Question,
That this House doth agree with the Committee in their Resolution.—[Mr. John Ellis.]

put forthwith, pursuant to Standing Order No. 43 (Business Committee), and agreed to.

Following is the report of the Business Committee:
That the allotted days which under the Orders [20th July and 3rd August] are given to the proceedings on Consideration and Third Reading be allotted as shown in the Table below; and subject to the provisions of those Orders each part of the proceedings shall, if not previously brought to a conclusion, be brought to a conclusion at the time specified in the third column of that Table.

TABLE


Allotted day
Proceedings
Time for conclusion of proceedings


First day
Consideration
—


Second day
(a) Consideration
9.30 p.m.



(b) Third Reading
11.00 p.m.

Orders of the Day — HEALTH SERVICES BILL

[1ST ALLOTTED DAY]

As amended (in the Standing Committee), considered.

New Clause 1

AMENDMENT OF PROVISIONS ABOUT REGISTRATION OF NURSING HOMES AND PRIVATE HOSPITALS

(1) The paragraph set out in subsection (2) below shall be inserted—

(a) after paragraph (c) of section 4 of the Nursing Homes Act 1975, as paragraph (cc) and
(b) after paragraph (b) of the proviso in section 1(3) of the Nursing Homes Registration (Scotland) Act 1938, as paragraph (bb),
so as to afford, in each case, an additional ground for refusing to register, or cancelling the registration of, a person in respect of a nursing home or mental nursing home.

(2) The said paragraph is—
( )that the home or any premises to be used in connection therewith consist of or include works executed in contravention of section 12(1) of the Health Services Act 1976;".

(3) In section 16(1) of the Mental Health (Scotland) Act 1960 (prerequisites of registration of private hospital) the following paragraph shall be inserted after paragraph (b)—
(bb) that neither the hospital nor any premises to be used in connection therewith consist of or include works executed in contravention of section 12(1) of the Health Services Act 1976;".

(4) In each of the following provisions (penalties for carrying on a nursing home, mental nursing home or private hospital without registration) namely—

(a) section 12 of the Nursing Homes Act 1975;
(b) section 1(1) of the Nursing Homes Registration (Scotland) Act 1938;
(c) section 22(1) of the Mental Health (Scotland) Act 1960;
for the words from "shall be liable" onwards there shall be substituted the words "shall be liable on summary conviction to a fine not exceeding £400 or on conviction on indictment to a fine".'.—[Mr. Ennals.]

Brought up, and read the First time.

4.18 p.m.

The Secretary of State for Social Services (Mr. David Ennals): I beg to

move, That the clause be read a Second time.

Mr. Speaker: With this clause we may take Government Amendment No. 59.

Mr. Ennals: This clause removes from the Bill the powers of the Secretary of State to amend by regulations Acts under which registration is a prerequisite for the carrying on of a nursing home, mental nursing home or private hospital so as to make contravention of Clause 12 of the Bill an additional ground on which registration may or must be refused or cancelled.
New Clause 1 amends the Nursing Homes Act 1975, the Nursing Homes Registration (Scotland) Act 1938 and the Mental Health (Scotland) Act 1960 so as to introduce an additional ground for refusing to register or for cancelling the registration of the manager of a nursing home. The grounds would be that the home or hospital or premises in question consists of or includes works executed in contravention of Section 12(1) of the Health Services Act 1976. The amendment would increase the maximum penalty for carrying on a nursing home, mental nursing home or private hospital without registration to a fine not exceeding £400 or on conviction on indictment to a fine of unlimited amount.
During debate in Committee on the regulation-making powers under Clause 16 there was considerable discussion of whether it was proper to include in a Bill a power such as that contained in Clause 16(4)(b) to amend other Acts by regulation. The right hon. Member for Wanstead and Woodford (Mr. Jenkin) quoted the views of the Donoughmore Committee—

Mr. Patrick Jenkin: May we establish whether we are to refer to the column numbers of our Committee proceedings in the daily parts or in the bound volume? They are quite different. It would be helpful if at this stage we could make a decision. Otherwise we may be in some difficulty.

Mr. Ennals: At the moment I am operating on the daily part. I am perfectly prepared to have private discussions, through the usual channels, so that we


may talk the same language. I am quoting what the right hon. Gentleman said. He said, quoting Donoughmore:
It cannot but be regarded as inconsistent with the principles of Parliamentary government that the subordinate law-making authority should be given by the superior law-making authority power to amend a statute which has been passed by the superior authority."— [Official Report, Standing Committee D, 27th July 1976, c. 1575.]
I thought that was a tremendous sentence.
The Government have reconsidered Clause 16(3)(b) in the light of the views of the Donoughmore Committee and also of the Renton Committee's agreement with the opinion of the Law Society that:
only details which may require comparatively frequent modification should be delegated to statutory instruments".
We now accept that the intended amendments to the nursing homes legislation should be incorporated in the Health Services Bill. That is what this proposal does and I hope that the House will agree to it.

Mr. Patrick Jenkin: I do not think we need waste too much time on the new clause. I am very much obliged to the Secretary of State for having taken so completely the point that we addressed to him in Committee. I rise only to say that I hope that those who are responsible for drafting Bills will take note of the fact that we had to spend considerable time in Committee arguing against this "Henry VIII Clause", which was what the Donoughmore Committee called the power to amend other legislation and in the end the Government have decided that it is right to table a new clause at this stage.
I do not say that the Conservative Party can stand here in a white sheet and say we never did it; yet, it is a highly unsatisfactory way of legislating. If we want to amend Acts, they should be amended by another Act. One should not take a generalised power to do this by regulation. We cannot amend regulations; we can only reject them or accept them. Often they do not come before the House at all, because there is no time and if there is time they can be taken in Committee upstairs. It is not right that legislation should be amended in that way.
I therefore urge the Secretary of State, while thanking him for meeting our points so completely today, to see that those responsible for drafting Bills do not do it again.

Question put and agreed to.

Clause read a Second time, and added to the Bill.

New Clause 2

COMPLETE WITHDRAWAL OF N.H.S. BEDS FROM RESIDENT PRIVATE PATIENTS AND TRANSFER OF BOARD'S FUNCTIONS TO SECRETARY OF STATE

If the Board under the provisions of this Act have not submitted to the Secretary of State by 1st January 1980 proposals for the complete withdrawal of National Health Service facilities from private patients, then:

(1) Notwithstanding the provisions of this Act for securing the progressive withdrawal of accommodation and services at National Health Service hospitals from use in connection with the treatment of persons at such hospitals as resident or non-resident private patients, the Secretary of State shall not later than 1st January 1980 reduce to nil the number of beds authorised under section 1(1) of the 1968 Act to be made available to resident private patients.

(2) So soon as the Secretary of State has affected the reduction in the number of beds under subsection (I) of this section, the functions of the Board under Part III of this Act shall be transferred to the Secretary of State and Part III shall be read accordingly.'—[Mr. Pavitt]

Brought up, and read the First time.

Mr. Laurie Pavitt: I beg to move, That the clause be read a Second time.

Mr. Deputy Speaker (Mr. Oscar Murton): With this we may take the following:

Amendment (a), in the first paragraph, leave out '1980' and insert '1978'.

Amendment (b), in subsection (1), leave out '1980' and insert '1978'.

New Clause 4—(Commencement of Part 11 of Act).

Amendment No. 8, in Clause 3, page 3, line 1, leave out 'passing' and insert:
'coming into force of this Part'.

Amendment No. 50, in Clause 11, page 14, line 2, leave out 'Act is passed' and insert:
'this part of this Act comes into force'.

Amendment No. 63, in Clause 23, page 24, line 19, leave out 'two' and insert 'twelve'.

Amendment No. 64, in page 24, line 19, leave out 'this Act is passed' and insert:
'Part II of this Act comes into force'.

Mr. Pavitt: In moving New Clause 2, I should like to give thanks to the printers of the House because the new clause would seem to have so much merit that they printed it twice on the Amendment Paper, once as New Clause 2 and again as New Clause 7. Perhaps they may have good reason to see the value of the new clause inasmuch as there are more than 80 signatories from the Back Benches on this side of the House in support of the principles contained in it. When we get more than 80 signatories from the Back Benches when my party is in Government, they represent nearly everybody except Ministers, Parliamentary Private Secretaries and other hon. Members attached specifically to the Government.
The purpose of the new clause is quite simple. In Committee we argued the case time and again that the compromise which the Government had entered into, which found its expression in the framing of the Bill, was not acceptable to all members of the Committee or to all Members of the House. One of the greatest problems we found was not concerned with the first part of the Bill, in Part II, under which 1,000 beds would be phased out and taken outside the National Health Service. These pay beds under Section 5 of the original Act would be taken out within six months from the time the Act went on to the statute book. The problem rested with the remaining 3,500, because their phasing out seems to be absolutely open-ended. Many of us feel that under the provisions of the Act, and without the new clause, some pay beds will still be in existence long after my grandchildren may be seeking the services of the National Health Service.
I assure my right hon. Friend that we understand fully the Government's position in this matter. I say that also to my right hon. Friend the Member for Blackburn (Mrs. Castle), who had prime responsibility at the time when the negotiations were reached with the various interests under the arbitration of Lord Goodman. We understand that, having

reluctantly reached a compromise which may have been unsatisfactory to them even at the time, nevertheless the Government must continue to try to follow their part of the agreement. I take the view that they were acting very much under duress. There was a tremendous amount of pressure coming from consultants, specialists and others inside the hospital service, and in order to seek progress the Government were more or less forced to accept a compromise which in other circumstances they would have been unlikely to accept.
It has been said time and again in the House and in Committee that the Government are perfectly entitled to reach executive decisions and to make such compromises if they wish, but in the last anlysis any such agreement which in enshrined in legislation can be passed only by this House, because ultimate responsibility rests with Parliament and not with the Government. It is because we have that right that I am seeking to exercise it in New Clause 2, which would make alterations to the compromise agreement accepted by the Government.
One of the things which gave me cause for great alarm and disquiet was the newspaper articles written by Lord Goodman which appeared after the statement by my right hon. Friend's predecessor about the agreement on 15th December. Lord Goodman made it abundantly clear that he was not an independent arbitrator not having a view. He was an arbitrator with a view, and his view was that private practice should remain inside the National Health Service. His view was that, as a result of the compromise, pay beds would remain inside the National Health Service for a long time. That is why I seek in the new clause to make a termination date.
By setting a terminal date of 1st January 1980, I think I am giving a fair chance for the board which will be established and for the other arrangements within the Bill to have some time, as distinct from Amendments (a) and (b). I understand fully the point of view of my hon. Friends the Members for Ealing, North (Mr. Molloy) and Fife, Central (Mr. Hamilton), who seek to bring the time much closer to the first six months, and if it were possible I would welcome a shorter time. However, I have tried to be fair, giving perhaps more time


than is necessary, because I hope that I am a fairly reasonable Member of the House.
The time limit that I have given is sufficient for the board to do the job within the terms of the compromise and within the terms of the Bill. By so doing, if we put the new clause into the Bill we would relieve thousands of patients from months of sheer misery where acute discomfort and pain are aggravated by continued anxiety and mental stress.
I give the House two examples of why think I can make that claim. First, I refer to gynaecology. I believe that if there were more lady Members of the House there might be more force behind this argument. In no area of clinical medicine inside hospitals, including both in-patient and out-patient sectors, do we get greater stress area than at the time when a woman reaches the change in life and because of this, biologically and psychologically, she needs to have a good deal of medical attention. Our consultants and specialists in hospitals are first class inasmuch as they will never at any time refuse to admit and immediately deal with matters of urgency which relate to the illness of a patient.
4.30 p.m.
In a number of specialities, however, the treatment which is needed can be deferred for a while. In gynaecology this means in physical terms—which men can understand only theoretically—months and months of acute discomfort, pain and anxiety. But one does not die from it, and eventually one can have one's treatment. The fact that a woman may have to wait some time is unfortunate, but she puts up with it. Perhaps because women are braver than men—I suppose that I risk being called a chauvinistic feminist in saying that—because they are used to bearing pain, they accept this situation too readily.
One example has arisen in my constituency within only the last three weeks. One of my constituents had been waiting for two years for the call to hospital for 44 "gynae" treatment. In despair in such situations, one hopes that each day will be the day when the post brings the summons to enter a hospital ward. This call was for admission to the Willesden General Hospital. Fortunately, one par-

liamentary privilege is the use of the telephone on behalf of one's constituents, and I am pleased to say that after two years my constituent has now had the necessary treatment.
I understand the position of the consultant with a heavy case load and waiting list who cannot deal with all the people who need treatment. He has to make some choice and in gynaecological cases he becomes case-hardened; even if he works full stretch, he will still have a heavier work load than he can manage.
The present situation of Section 5 beds and private practice and the ability to go to Harley Street and pay to jump the queue has two results. Apart from giving the consultant an added income, it helps to resolve his responsibility of making difficult choices when he does not have all the social data, such as how many children the woman has and what her home conditions are. On this ground alone, therefore, I commend the terminal date in New Clause 2.
This problem does not apply only to females. Another example that I should like to quote never affects females. That is the classic case of prostatectomies. The details of one case reached me only yesterday. They concern a hospital in the area of the Stockport Area Health Authority. Over the years I have had an interest in the National Health Service, and when these matters are before the public and the Press I get a large correspondence from all over the country. This letter is typical of a number that I have received since Second Reading.
The patient in question was referred to the hospital by his general practitioner in September 1972. Ten months later he went to the hospital and saw the specialist. Two months later he had the results of his X-rays. On 3rd January 1973 he saw the specialist with the results of his X-rays, and the specialist said that an operation was vitally necessary. Then there was dead silence until three weeks ago, in 1976, when a circular from the area health authority asked whether he still wanted the operation.
There is an atmosphere of unconcern which appals the layman. The majority of patients, as their name implies, have more patience than one would expect. They do not go worrying the doctor. If


they are told that an appointment is to be made, they simply wait and wait.
After two years of agony, my correspondent had the operation done privately. He finishes with these words:
I think the performance of the hospital shows a complete lack of consideration … so far as they know I am still in pain after 3¾ years waiting for the post every day for the call to go to hospital.
By inserting a terminal date we will ensure that the phasing out of pay beds means that this kind of story will also have a terminal date and that the thousands of patients in these two categories will not find that the only way to get rid of their pain and anxiety is to jump the queue. If they do so, they may be jumping a queue of others in equal clinical need and perhaps worse social conditions.
In framing the new clause, I naturally looked to our debates in 1973 on the reorganisation of the NHS to see whether there were other ways of achieving my purposes. Alas, there are not. I agree with this conclusion:
We trained hard, but it seemed that every time we were beginning to form up into teams, we would be reorganised. I was to learn later in life that we tend to meet any new situation by reorganising, and a wonderful method it can be for creating the illusion of progress while producing confusion, inefficiency and demoralisation.
Apt as that might be to the 1973 Act, in fact it was said nearly 2,000 years ago, in 66 AD, by Petronius Arbiter.
Subsection (2) of the new clause is consequential on the subsection (1). Thanks to the noble Lord's compromise, we are erecting a massive machinery. There will be a board of five people trying to phase out 4,500 of the 500,000 beds in the NHS. There will be a Scottish Committee, a Welsh Committee, all the necessary civil servants, filing clerks, typists and offices to back up that machinery. If we can achieve the terminal date which I suggest, it seems nonsense to preserve that machinery at great public cost. No one is more anxious than Conservative Members to contain public expenditure. This machinery is needed for other purposes—other parts of the Bill deal with other important provisions —to ensure that private practice stands on its own feet without the taxpayer's help.
I hope that subsection (2) will ensure that we shall also phase out the costly machinery and revert to the Secretary of State to exercise responsibility under other parts of the Bill dealing with private practice carried on the back of When the last pay bed is phased out after two and a half years and these beds can be used particularly for the young chronic sick—at the moment there is a gross shortage of beds for such patients —these 3,500 would help to implement that part of the Chronically Sick and Disabled Persons Act 1970.
Without a definite date for the end of private practice carried on the back of the NHS, we not only extend the years of conflict and unrest and the tensions within the NHS between different sections of personnel—medical, ancillary and auxiliary—but we also set up a barrier to grappling with some of the far more important problems facing the NHS. These problems must be overcome if we are to give the kind of service that we all should like to see given to the sick and disabled, who need our help most. I therefore hope that the House will give the new clause a Second Reading.

Mr. Patrick Jenkin: I was a little astonished that the hon. Member for Brent, South (Mr. Pavitt), to whom we have listened with pleasure, should have sought to commend his clause to his right hon. Friend by saying that it bore the signatures of over 80 of his right hon. and hon. Friends. I should have thought that, after the events at Blackpool the week before last, the larger the number of signatures it bore, the less likely it was to commend itself to his right hon. Friend.
We are debating this Bill against the background of the most serious economic crisis we have faced since the war. There is no dispute that the crisis arises because of the huge Budget deficit which has to be covered by borrowing. There is no dispute that we needed a 15 per cent. minimum lending rate to be able to finance the deficit—although we seem to be back, after less than a week. to the level the pound had reached before that rate was imposed.
There is no dispute that there are nearly 1½ million unemployed as a direct consequence of inflation due to excess


Government spending. Yet, within a couple of days of coming back after the recess, we are to plunge into a Bill which if implemented at once, is bound to take the Government further down that which my right hon. Friend the Leader of the Opposition in a magnificent speech last night referred to as the wrong road. By simply chucking away tens of millions of pounds which would otherwise have flowed into the National Health Service through the use of private beds, the Government are making the problems worse.
There is no dispute that there will be the loss of at least £20 million a year from the phasing out of pay beds. We believe that the eventual loss will be even higher —nearer the estimate of £40 million which was based on figures supplied to the House by the right hon. Member for Blackburn (Mrs. Castle). That is money paid to the National Health Service by patients who are ready and willing to finance their own treatment—in many cases through insuring with provident funds. In other words this is money which pound for pound reduces the burden on the Exchequer of financing the National Health Service.
The Government have been at pains to point out that it is not the National Health Service that will suffer from the loss of this money but that the loss will be made up out of Exchequer moneys. That makes the Opposition's case precisely. Because of the loss of pay bed revenue, Exchequer borrowing is higher than it need be. Against the hundreds of millions of pounds that the Labour Party is seeking to squander on nationalisation, North Sea oil, indiscriminate subsidies and so on, the tens of millions of pounds involved in this Bill may not be significant. But when every extra pound borrowed pushes up interest rates and has an effect on inflation—and of course inflation causes unemployment—we are entitled to say "For God's sake abandon the Bill". At least the Government should put it on ice until the immediate crisis is over.
The Chancellor's ship is sinking fast and if the Bill is put into effect on the basis of the planned timetable, it will simply punch further holes in a hull that is already leaking. On social, economic and financial grounds alone it is utter madness to proceed with the Bill at present.

Mr. Kenneth Lomas: On a point of order. Will the right hon. Member for Wanstead and Woodford (Mr. Jenkin) address his remarks to New Clause 2. He is making a Second Reading speech, which is out of order. It would be acceptable to the House if he referred to the remarks made by my hon. Friend the Member for Brent, South (Mr. Pavitt).

Mr. Jenkin: That may be acceptable to the hon. Gentleman but I am addressing my remarks to New Clause 4.
We are asking for at least Part II of the Bill to be put on ice. In a period of acute financial crisis the nation simply cannot afford this ridiculous piece of Socialist nonsense.
There are other reasons why Part II should be put into cold storage. There is no dispute that there is a crisis of morale in the National Health Service, not just among doctors but among many others who are responsible for providing the services upon which patients depend.
The Secretary of State has been frank. In an interview with the Health and Social Service Journal at the beginning of the month he said:
I must make some contribution during my stay at the Department to improving the morale of staff in the health service.… the sense of commitment to patients has a much lower priority than it had. We have to go some way to recreate the spirit of commitment. But I do not want to put forward my ideas on how to do this yet.
How could he put forward ideas when the Government are thrusting through this absurd Bill with its damaging effect on morale within the service.
4.45 p.m.
Another reason for putting the Bill on ice is that we are now facing a virtual standstill in the growth of resources going into the service. The service is, too, still suffering from the disastrous regime of the right hon. Member for Blackburn when she made the service a plaything of Socialist politics. I agree that reorganisation created some problems, but Labour hon. Members are quick to forget the pressure, discussions and negotiations that went on for years before the National Health Service Reorganisation Act 1973 reached the statute book. The situation is


worsened now that that is to be combined with cuts in resources and the political shenanigans which the right hon. Lady played with the service.
The cuts are having severe consequences, particularly for the four Thames regions which are the hardest hit. I have two examples of what is happening and which illustrate why morale is so low. Yesterday I heard that the West Middlesex Hospital is currently closing 20 per cent. of surgical beds by removing the appropriate number of beds from each surgical ward. In the St. Mary's group of hospitals there is to be a withdrawal of all student nurses from 11 acute general medical and surgical wards. [Interruption.] I understand that hon. Members opposite do not want to hear the facts but they will have to. The withdrawal of student nurses will have a severe effect on teaching.
The examples that I have given are mirrored all over the country and are leading to despair in the service. What does the Secretary of State think will be the effect on morale if, after withdrawal, pay beds are closed down and do not become available to National Health Service patients? That is what is likely to happen as a result of the West Middlesex situation. There will not be enough money to keep open the 22 pay beds in the Ealing, Hammersmith and Hounslow AHA which are mentioned in the schedule.
Will that help morale in the service? What does the Secretary of State think will be the reaction of part-time consultants when they are told that there is no money to give them full-time consultancies? They will be without jobs or they will have to emigrate. Will that help morale? It is not surprising that the Secretary of State was coy when he told the Journal that he was not going to produce ideas for helping morale just now. These are compelling reasons for postponing phasing out. It does not make sense with the present resources of the service.
What about political interference? The Secretary of State was frank about why he replaced the right hon. Member for Blackburn. He was asked:
How do you differ, politically, from Barbara Castle?

He replied:
Because I am less militant and do not stride into battle with so much gusto as Barbara, I may be less effective. She enjoys an argument whereas I don't like conflict.
He was right. The right hon. Gentleman was brought in to restore peace and to try to bring back a little harmony into the NHS. Indeed, when he made a statement immediately after his appointment, he said:
I shall never seek confrontation for the sake of a fight. I shall try to mediate and conciliate.
Yet was he not desperately unwise not to see in his appointment an opportunity to drop the Bill and to try to do something to restore morale? Instead he let it go forward when he could scarcely have had time to read it.
We are now in a new ball game. The economic crisis is threatening, the NHS is having severe financial problems, and morale, on the right hon. Gentleman's own admission, is low. Surely this is the moment at which the Government might pause to consider whether they are not going down the wrong road. Can the right hon. Gentleman not even now recognise that by putting Part II of the Bill on ice he could do more for morale than by taking almost any other step?
There is a third reason—and here I come to the speech of the hon. Member for Brent, South. At no stage during the prolonged Committee proceedings were we given any convincing reason for the Bill. All we got, as we have had again today, was the same tired old Socialist complaints about queue-jumping.
The hon. Gentleman will remember that perhaps one of the most effective and constructive debates in Committee was on Clause 6, dealing with waiting lists and the proposal for the examination of common waiting lists. I am sure that all those who took part in the Committee will remember the profound analysis of the problems of waiting lists given by my hon. Friend the Member for Wells (Mr. Boscawen) in a speech which I am sure will be a source of guidance on these problems for a long time.
But throughout the debates on Clause 6, no Minister was unwise enough to seek to argue that the abolition of pay beds would have any effect at all on the waiting lists. Indeed, from the letter


sent by the Department whilst the right hon. Member for Blackburn was Secretary of State we know that the Department does not seek to argue that it will have any effect on the waiting lists, because the waiting lists stem from wholly different reasons.

Mr. Ennals: The right hon. Gentleman is absolutely wrong. It is untrue to say that in Committee no Minister was unwise enough to argue that the abolition of pay beds would have an effect on the waiting lists. On the contrary, every Minister clearly indicated the view that the passing of the Bill would make a contribution towards easing the problem of the waiting lists by releasing resources. We did not make any false claims that the passing of the Bill would of itself, without other means, resolve the problem of the waiting lists.
The right hon. Gentleman has quoted the Department's letter ad nauseam. We have made our position clear. This Bill will make a contribution towards resolving the very heavy problem of the waiting lists. Quite apart from the fact that the passing of the Bill will make provision for common waiting lists, it will ensure that people will not be able to buy their turn in the queue in NHS hospitals.

Mr. Jenkin: The waiting list argument is entirely different. If we were confronted with a measure to deal with those abuses identified by the Select Committee, with a measure that would examine the feasibility of common waiting lists, in the meantime retaining all the advantages flowing to the NHS and its patients from pay beds, the right hon. Gentleman might have found himself with an agreed measure. Instead, he proposes to chuck the pay beds out of the NHS and to get rid of the geographical whole-time consultants and the rest, when there is no evidence beyond the hope—which is really all that Ministers are able to say—that that may make some contribution. If pay beds are to be phased out only to be closed down altogether, where is the advantage to the waiting lists or to NHS patients? On this issue, the hon. Member for Brent, South is much more concerned to do down Dives than to help Lazarus. He is more concerned about

doctors' incomes than he is about the waiting lists of the patients.
I turn now to the question of abuse. There was a lot of reference to that in Committee. We disposed of it, very interestingly, in one brief debate on Clause 5, in which we exploded the argument that the Bill was necessary in order to prevent abuse. Clause 5(6) expressly preserves the provisions of Sections 1 and 2 of the Health Services and Public Health Act 1968. Section 1(6) of that Act says:
Nothing in this section shall prevent accommodation from being made available for a patient …
other than a private patient
if the use thereof is needed more urgently for him on medical grounds than for a patient so mentioned and no other suitable accommodation is available.
I asked the then Minister of State why that provision was not adequate to prevent abuse—not a question, I may say, ever asked in the Select Committee. I asked why it was not used. It is, after all, clearly in an Act passed by a Labour Government, and it provides that an NHS patient shall have priority if that is needed on medical grounds.
The Minister first answered a different question. He said that the process of phasing out could have been done without legislation, but I was not arguing that point. I was asking why Section 1(6) was not being used to prevent abuse. When pressed, the Minister gave an interesting answer. He said:
Secretaries of State under successive Governments did not interpret subsection (6) in the way I believe they could have done."—[Official Report, Standing Committee D, c. 744. 8th July 1976.]
With that one sentence the whole argument that this Bill is necessary to deal with abuse goes out of the window. It is wholly destroyed. So that is the answer to those who say that we have to have this Bill because it is necessary to deal with abuse.
Then there is the argument about the trade unions. I shall deal with the question of what the trade unions really think about the Bill. I accept that the activists in the trade unions, those who attend meetings and conferences, and their leaders, remain resolutely opposed to independent practice remaining in the


NHS, but I question whether that view is representative of the ordinary members of the unions concerned.
I quote one or two figures taken from a poll conducted by NOP, whose validity has not been impugned in any way. It is a highly professional survey of opinion based on a probability sample survey. I read it out in Committee and I shall not read again all the conditions under which the survey was taken. The question was asked:
Do you feel that the number of beds for private patients in NHS hospitals should be …
and the options were whether it should be increased, greatly increased or remain as it was, or whether it should be decreased, greatly decreased or removed altogether.
Of the members of NALGO interviewed, 71 per cent. said that the beds should remain as they were or be increased, while only 29 per cent. said that they should be decreased or removed altogether. Of the NUPE members interviewed, 62 per cent. fell in the first group and 30 per cent. in the second. The ASTMS members interviewed were even more extreme, for 74 per cent. of them agreed that the number of pay beds should either be increased or remain as it was, and only 16 per cent. felt that the number should be decreased or that the beds should be removed altogether. These figures are so overwhelming that those trade union leaders who profess to argue on the basis that abolition is what their members want are simply talking through their hats.

5.0 p.m.

Mr. Doug Hoyle: Who commissioned the survey? Is the right hon. Gentleman prepared to take the views of whoever commissioned the survey rather than the views of members expressed democratically through their trade unions?

Mr. Jenkin: Of course, it was commissioned by the Campaign for Independence in Medicine. [HON. MEMBERS: "Oh".] All right, but is the hon. Member for Nelson and Colne (Mr. Hoyle) saying that a highly professional organisation such as National Opinion Polls would fiddle the results to suit its clients? I concede at once that, if the results did

not suit the client, we should not have heard of them, but if the hon. Gentleman is seriously saying that NOP has fiddled the results to suit its clients, I invite him to say it outside.

Mr. Hoyle: I invite the right hon. Gentleman to say whether he is prepared to take the views of the survey rather than the views of the members of trade unions expressed democratically through their annual delegate conferences. I ask that question again.

Mr. Jenkin: If the hon. Member is sincerely saying that the views of delegate conferences represent the views of the members of their unions, he can try to persuade some of his hon. Friends of that, but he will not convince us.
Again and again the views of the great mass of members of the unions are not represented by the activist leaders. I am quoting the polled opinions of individual union members. The opinion survey even asked the political affiliations of those who were questioned. The same questions were put to those who professed to be Labour supporters—"Should the number of beds be increased or stay the same, or be reduced or taken out altogether?"—and in that case 54 per cent. said that the number should remain as it was or be increased and only 39 per cent. said that it should be reduced.
Plainly, therefore, hon. Members on the Government side do not even speak for their own party, because people outside realise the madness of what they propose. The result was the same with all the other questions. When the specific question was put as to whether people agreed with the proposals of the right hon. Lady the Member for Blackburn to phase out 1,000 beds, the figures were even more remarkable than those I have already given.
All this adds up to an overwhelming case against proceeding with phasing out now. The country cannot afford the cost. The National Health Service cannot afford the loss of revenue. The policy is gravely damaging morale throughout the National Health Service. There is no evidence that it is in the interests of health service patients either on waiting lists or in relation to abuses of the scheme. Moreover, there is no evidence that the policy has the support even of those whose organisations are calling for it most loudly.
There must be time for the whole question to be considered by the Royal Commission as part of its study of the finances and manpower of the National Health Service. The Government have had opportunity after opportunity to get themselves off the hook on which they hung themselves in their 1974 manifestos. The right hon. Member for Huyton (Sir H. Wilson) had an opportunity when he announced the appointment of the Royal Commission on 20th October last year. There was another opportunity during the crisis talks at No. 10 Downing Street which led up to the Goodman compromise. There was an opportunity after the CCHMS ballot in February this year which showed an overwhelming majority of consultants against the two main proposals in the Bill.
There was another opportunity when the present Secretary of State took office. He could have asked for time for thought as to whether he ought to proceed with such a divisive measure. There was an opportunity when it became apparent in July that only through the unprecedented use of the guillotine procedure combining five Bills in one motion could the Government save their legislative programme.
In New Clause 4 we are now giving the Government another opportunity. I ask the Secretary of State to seize it, to accept New Clause 4, to put Part II on ice and to let the Royal Commission have a look at it.

Mr. Lomas: I have not entered the debate with any prepared notes. I have always assumed in the time that I have been in the House that the right hon. Member for Wanstead and Woodford (Mr. Jenkin) has been a rational and reasonable human being, but what we heard from him today seemed to be touched by the winds of Brighton. Indeed, even his Leader got mixed up between Blackpool and Brighton, and I am not sure sometimes which conference she was at.
It seems to me that New Clause 2, moved by my hon. Friend the Member for Brent, South (Mr. Pavitt), makes admirable sense. I am not speaking entirely on behalf of my own union, the National Union of Public Employees. I accept most of what it says, but I recognise also that I have an obligation to my

constituents, to my constituency party and, indeed, to the House to speak the truth. I believe that the time is right for private beds in the National Health Service hospitals to be abolished. That seems to me to be the right thing to establish.
I appreciate also, from personal experience over the last two and half years, the tremendous amount of hard work that is done by junior doctors and consultants, and I respect their request for clinical judgment and freedom in dealing with the many problems that come before them. I hope that we on the Government side recognise that fact and that they are entitled to exercise their judgment as they think fit. But the proposal in New Clause 2 is simple, that
If the Board under the provisions of this Act have not submitted to the Secretary of State by 1st January 1980
—that is four years hence—
proposals for the complete withdrawal of National Health Service facilities from private patients, then:
(1) Notwithstanding the provisions of this Act for securing the progressive withdrawal of accommodation and services at National Health Service hospitals from use in connection with the treatment of persons at such hospitals as resident or non-resident private patients, the Secretary of State shall not later than 1st January 1980 reduce to nil the number of beds authorised under section 1(1) of the 1968 Act to be made available to resident private patients.
As I say, that seems to make sense. Why should we not move with the times? I shall not drag in the hoary old argument which the Opposition have heard from us many times, true though it may be, that it was they who, in the late 1940s, voted against the introduction of the National Health Service to begin with.

Mrs. Jill Knight: rose—

Mr. Lomas: I need no interruption from the hon. Lady, because we see that the Conservative Party has now come round to the point. However, I give way.

Mrs. Knight: I am obliged to the hon. Gentleman. Is he aware that Mr. Aneurin Bevan at that time gave a solemn pledge and promise that the treatment of private patients would be allowed in NHS hospitals?

Mrs. Renée Short: A long time ago.

Mrs. Knight: It was the hon. Gentleman who referred to it, not I.

Mr. Lomas: The hon. Lady may be described by Andrew Roth as a "cuddly toy", but in my opinion she is totally misleading the House. When Nye Bevan introduced the National Health Service Bill, he made perfectly clear at that time —one has only to look back at the various volumes of Hansard—that in order to get the co-operation of the doctors working inside the health service he made a compromise and said that there should be a limited amount of private practice allowed under the National Health Service Act itself. Fair enough. I am now saying that, 30 years on, the time has come to look at this again. We should now question whether it is right that public money should be put into the National Health Service and at the same time there should be people who gain advantages in terms of private practice.
As I say, I fully appreciate the right of consultants and doctors to have freedom of clinical judgment in their cases. I am not against private practice, but I am against private practice being operated inside the National Health Service as such.
However, there is a dilemma here. If we say that private practice should be divorced from the National Health Service, and if as a consequence there is the building of new hospitals or private nursing homes—whatever they may be—we have to face the possibility that the best doctors and the best consultants may be attracted from the public sector to the private sector. I do not want that to happen.
The vast majority of people who enter hospital are entitled to, and receive, the best clinical treatment and judgment that can be given by doctors, nurses and consultants. The proposition in New Clause 2 is perfectly reasonable. We are giving four years in which to phase out private practice from National Health Service hospitals. I do not think that we have present any hon. Member representing CHSE, which sought to insert 1978 instead of 1980 in Amendments (a) and (b) to New Clause 2.
That is a pity. Private practice in itself may be all right, provided it is carried on outside the NHS and does not create a two-tier system, which is what worries me. If I had my way, in a perfect world there would be only one kind of health service, open to all, in which doctors, consultants and nurses work for the good of the community and people had no longer the right to buy good health.
I have spent some time in hospital over the past two or three years. I was treated as an emergency case, as someone who had to be taken into hospital, not because I was a Member of Parliament. That is what the NHS is all about. We rightly say that if a person's needs are such that he should be treated we shall deal with him and he will have the best assistance and advice from consultants and doctors, and this I believe to be true.
I cannot understand the right hon. Member for Wanstead and Woodford, who has led the opposition to these proposals, arguing that New Clause 2 should be ignored. Is it not right that 30 years on we should think of making the NHS what its title says it is—a National Health Service, for the good of all?
I accept the Goodman proposals. My union probably will not like my saying that, but I am prepared to tell it and the House the facts of life. I accept the proposals because I do not see any way out of doing so. We could play clever and put down many amendments which would no doubt please Alan Fisher and the whole of the NUPE executive. They would say what a marvellous job I had done. But I do not want to do it, because the amendments would not be passed. I have been in politics since 1937, and have a great deal of experience —more experience of politics than many trade union leaders, quite apart from Conservative Members.
5.15 p.m.
I agree with my right hon. Friend the Secretary of State that the Goodman proposals are in line with what the Labour Party said it would do. They mean the beginning of the phasing out of pay beds. It seems to me logical to carry that process to its conclusion by New Clause 2, on which I hope the House will divide, by saying that by 1980 there shall be no private patients in National Health Service hospitals.


That is a legitimate step forward. Without it, we are standing still. The hon. Member for Birmingham, Edgbaston (Mrs. Knight), who is known in the House and outside for various views, must accept the logic that as we advance as a nation, we advance in our concern for the aged, the sick the weak and the feeble.
Let us be sensible and stop being bloody politicians. Like it or not, the fact is that we shall accept the Goodman proposals. No matter what great speeches are made from dizzy heights at Blackpool or Brighton, on this side of the House or from the Opposition Benches, a thousand beds will go and 3,500 will then go to a commission to decide where they will end up. We are saying in New Clause 2 that by 1980 they must all go.
The House should accept the arguments and, when the Division comes, recognise the inevitability. We should recognise that doctors, nurses, junior doctors and consultants have a right to be consulted on the matter, and we have four years in which to do it. But let us not create a two-tier system, a first-class and second-class health service. We do not want that. Let us create one service that is good for everybody. Let us say that those who need operations or other assistance shall receive it as of right and shall not have to wait. Let us have a common waiting list. That is an eminently sensible proposition. If necessary, I am prepared to be a Teller for a Division on New Clause 2 if my hon. Friend the Member for Brent, South cares to put it to the vote.

Mr. Paul Dean: I agree with some of the points made by the hon. Member for Huddersfield, West (Mr. Lomas), but I find it difficult to agree with many of his conclusions. However, the whole House is pleased to see him back after his illness, in good voice and addressing the House on the Bill.
Yesterday's debate on the economy was at least relevant to the grave problems facing the country. Today and for most of the next four weeks the Government intend that we shall spend most of our time debating Bills which are totally irrelevant to the economic crisis, Bills which will aggravate our severe economic problems and divide and distract the

nation, when the Government should be giving a lead for a united national effort. I suppose that after Blackpool it is too much to hope that the Government will listen to the nation, that they will govern in the national interest and put aside divisive legislation instead of being led by a Left-Wing minority. If they will not do that, at least they should recognise that after long months of debate they have failed to make out a case for the Bill. If they dare not abandon it for fear of the wrath of Blackpool, they could postpone it, as New Clause 4 suggests.
We are told that there is a mandate for the Bill and that therefore it must proceed, but since when have fewer than 30 per cent. of the electors constituted a mandate for a Bill? What about the evidence in recent opinion polls which shows that a large proportion of people, including Labour supporters, are opposed to the Bill? What sense of responsibility can there be in bashing on, regardless of changed circumstances and the economic crisis?
The main reason why Part II should be postponed is that it will aggravate the pressure and problems facing the National Health Service. We are not talking in the Bill only about private patients and about private practice. We are talking about the future health or ill-health, the future strength or weakness, of the National Health Service and of National Health Service patients.
What does the National Health Service need above all else? It needs money and it needs skilled men and women. But our case, which has never been answered by the Government, is that it will lose on both these counts as a result of the Bill.
It is beyond argument that the National Health Service will lose tens of millions of pounds of revenue from private patients as a result of the Bill, at a time when the National Health Service is more short of money and when the prospects of getting money are more gloomy than for many years.
But it is not only the revenue from the private patients at home that is involved. There is also the loss of revenue from patients from abroad. This is an aspect on which it is extremely difficult to put a figure, but it is absolutely sure that the loss of revenue from patients both at


home and abroad will deprive the National Health Service of much-needed money.
Another aspect on the financial side, which was discussed at some length in Committee, is the effect of the Bill in diminishing the valuable source of donations and the like which at the present moment go into education, into training and into research. When we probed in Committee as to the likely effects of the Bill on money going into research from grateful patients and from other private sources, and asked the Government how much they felt would be lost in this respect, they had to admit their ignorance—that they simply did not know how much would be lost.
The evidence that we were able to produce from those running the medical schools of Britain suggests that here is another loss of revenue which will be bad for the National Health Service, bad for National Health Service patients, and which could well have a serious effect on the future of research, which is so important for the National Health Service.
Then there is the effect on skilled men and women—a point which the hon. Member for Huddersfield, West mentioned a few minutes ago in his speech. Here we have to remember that medicine is international. Thank goodness, one of the things in which our country is still world renowned—and justifiably so—is the quality of our medical schools. A doctor trained in this country, if he finds that conditions here are not suitable to him, can emigrate and command a good job in any country of the world. including advanced countries such as the United States or Canada. Many British doctors are holding down key positions in those countries and gaining key positions because of their training in this country.
Medicine being international, we cannot hold skilled medical manpower here unless it wishes to stay. If the conditions are hostile, and there is a fear that clinical freedom will be put into second place and political considerations put into first place, these skilled men will emigrate. They will go where their skills will be better appreciated, and where they feel they can use them to the benefit of their patients without extraneous political considerations being introduced. This is all

linked with the crisis in morale, to which my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin) referred a short while ago.
A third aspect of importance concerning the men and women in the service is the most effective use of their time. One of the arguments that we have put time and time again during the passage of the Bill is that once the National Health Service patients and the private patients are separated, and have to be treated in different buildings, probably miles apart, there will be less effective use of skilled and scarce medical manpower because of the travelling time and other factors involved.
This is an area in which I disagree with what the hon. Member for Huddersfield, West said. He maintained that if the Bill is passed and pay beds are phased out, we shall no longer have two different standards of service. I suggest to the hon. Gentleman that the opposite is likely to happen, and that we shall have different standards building up. Rather than having the services collectively used for the patients as a whole, we shall find barriers and divisions building up which do not exist at the present moment. Therefore, from a very similar premise to that which the hon. Gentleman put forward, I draw the opposite conclusion.
My final point concerns the Royal Commission on the National Health Service. The Secretary of State who is now in charge of the Bill took it over at a very late hour. It was virtually published when he took over, and it is understandable in many ways that he could not go back on a process which had already gone so far. But at least now the Secretary of State has the opportunity to postpone this legislation in order to give the Royal Commission a real opportunity to look at the whole question.
It is clear from the terms of reference of the Royal Commission that the matters we have discussed during the passage of the Bill are relevant to the inquiry. I therefore appeal once again to the right hon. Gentleman to use the opportunity to enable the Royal Commission to consider the question in its entirety. I appeal to him to recognise that in present economic circumstances it would be an act of folly, and bad for the National Health


Service and for the National Health Service patients to proceed at this time with this divisive legislation.

Mr. Stan Thorne: It was most unfortunate that the right hon. Member for Wanstead and Woodford (Mr. Jenkin), in opposing New Clause 2 and advocating New Clause 4, found it necessary again to refer to my right hon. Friend the Member for Blackburn (Mrs. Castle) and the role she has played in regard to the National Health Service. It must be recognised, and has been recognised from time to time in the House, that in the debates which have taken place in the Cabinet over the past two years concerning the level of public expenditure, the right hon. Lady has put up a tremendous fight within the Cabinet to protect the National Health Service from the cuts that the Government wished to impose upon it.
In the period since 1948, for about half the time the Conservative Party has been in power, and for the rest of the time the Labour Party has been in power. I believe, along with a number of other hon. Members, that neither party has anything to be particularly proud about concerning the allocation of resources to the National Health Service. But, if we compare the performances of the Conservative and Labour Governments during this period, we are forced to the conclusion that the Labour Party has protected the National Health Service far better than the Conservative Party has done. In this regard the right hon. Lady has done a tremendous job.

Mr. Pavitt: I am grateful to my hon. Friend for giving way to me because the right hon. Member for Wanstead and Woodford (Mr. Jenkin) made a swingeing attack upon my right hon. Friend the Member for Blackburn (Mrs. Castle) and then refused to give way. However, I am delighted that my hon. Friend the Member for Preston, South (Mr. Thorne) has put the record straight. We had an increase of £880 million under my right hon. Friend the Member for Blackburn, and we went up to 5·4 per cent. for the first time. Even with the cuts which have now been announced, we are to have £6,500 million for the National Health Service, and a good deal of the credit for that must go to the present Secretary of

State and to my right hon. Friend the Member for Blackburn.

5.30 p.m.

Mr. Thorne: I am indebted to my hon. Friend the Member for Brent, South (Mr. Pavitt) for putting that on the record. It is essential to get some of these matters on the record so that people understand the arguments.
I was saying that the right hon. Member for Wanstead and Woodford was being perfectly reasonable when he argued that the present economic situation was relevant to any decision of this House in favour of New Clause 4. He was right to bring in the public expenditure cuts. However, some of us are entitled to remind him that those, paradoxically or coincidentally, who are now interested in the progress of this Bill have also been extremely concerned about these public expenditure cuts. In fact, we have argued against the cuts in the National Health Service when he and his party have been advocating higher cuts in the services. I shudder to think where we would have been had they been involved in applying those cuts.

Mr. Patrick Jenkin: Perhaps I might be allowed to repeat what I said to a conference of the Institute of Health Service Administrators. In the consideration of public expenditure which we on this side of the House are giving, we are not currently looking for further cuts in spending in this area. It is true that we have in mind charges, as I am sure, does the Secretary of State, and we shall no doubt consider them in relation to the problem of motor insurance. But at the moment we are not looking for cuts. The National Health Service needs all the resources that it can get.

Mr. Thorne: I hope that I shall be forgiven for suggesting that some of the speeches made by Opposition Members outside this House are not quite like those which they make in this Chamber. I have distinct recollections that their party would slash the social services, the health service, housing and various other sectors far more viciously than this Government have done, and we on the Government side of the House have at least been consistent in our criticism of the Government in respect of public expenditure cuts.
My chief interest is in New Clause 2, and I hope that the House will divide upon it because it seems to me that the Government are on the wrong course. I understand the position of my right hon. Friend the Member for Blackburn. I appreciate that she may find it difficult to follow others of us into the Division Lobby in favour of New Clause 2. However, it seems to me that it is consistent with our view about public expenditure cuts to argue in favour of the new clause.
Put in simple terms, pay beds mean privilege for an elite in our society. They mean access to treatment via the cheque book. When Aneurin Bevan set up the National Health Service, he had in mind a free health service in times of need. To a great degree, he bought that by accepting pay beds within the health service, and in my view he regretted ever having done so. I believe that the job on which we are engaged at present is putting right that piece of blackmail which occurred at that time.
The Opposition, consistent with their general practices, are trying to protect the profits of the consultants in the health service. Their concern for the patient is revealed by the discussions that we had in Committee on this question.
For me, common waiting lists mean that there can be no queue-jumping. Queue-jumping takes place among people who are able to go to a consultant and pay £200 or £300 to get a hospital bed. Everyone knows that it takes place. It has occurred in my own constituency in the past few weeks.
My hon. Friend the Member for Huddersfield, West (Mr. Lomas) spoke about private medicine. I regret that private medicine is not really at issue in this Bill. To some degree the Bill tends to institutionalise private medicine. I should like to erase private medicine altogether. Others of my colleagues would like to maintain it. So long as we have a position in education, in health or in any other sphere where access can be obtained on the basis of wealth, we shall have the sort of class divisions that we see in our society today and the poor will always find it difficult to get their rights.
It seems to me, therefore, that private medicine, private schooling, private this

and private that should be opposed on moral grounds as well as on political grounds. It is with those considerations in mind that I hope that there will be a considerable vote in favour of New Clasue 2.

Lord James Douglas-Hamilton: It is always refreshing to listen to speeches by the hon. Member for Preston, South (Mr. Thorne) because we always know exactly where we stand with him. He has made his position perfectly clear. He would like to see the end of the private health service. However, when he touches on the question of cuts, he puts his finger on the nub of the whole matter because in Scotland today, for example, we find that these cuts are hitting very hard in certain areas, especially in Strathclyde, where home helps cannot be provided and where this is a very sore point in that area in which 2 million people live. I suggest to the hon. Member for Preston, South that throwing away an enormous amount of income will not help the National Health Service.
The Opposition are not opposed to the principle of the creation of a common waiting list. Certainly none of the representations which I have received from medical practitioners in Scotland has objected to the principle of a common waiting list. What they object to is the throwing away of a great deal of income at a time when cuts are biting very hard.
It is only fair to mention that during the Committee stage of this Bill a Scottish Office Minister was always present. I notice today that there is no Labour Member present in the Chamber who represents a Scottish seat. Since Scotland is very much in issue and since health has not yet been devolved to a Scottish Assembly, I think that it is only right that a Scottish Office Minister should be listening to these debates.
Scotland has 5·3 per cent. of the pay beds in Britain. The plan at present is to phase them out at a rate of roughly 50 a year, which would mean that within five years all the pay beds in Scotland would have disappeared. In 1974–75, the income from those beds was £536,749. In a Parliamentary Answer on 21st June, a Scottish Office Minister confirmed that the cumulative annual loss would eventually amount to £450,000. Taking


inflation into account, I suggest that in five years the cumulative annual loss will be in excess of £600,000. Besides that, the running costs of the Scottish Committee in the first year will be £25,000. A similar sum will represent the costs of the Welsh Committee. The Health Services Board itself will cost £205,000 in the first year of operation. So, we shall have additional public expenditure of £225,000, and in Scotland alone we shall eventually have a loss of income amounting. to £600,000.
If we had an abundance of money, this would not matter so much. But we do not. I have pointed out already that home helps have been cut out in Strathclyde. There is strong feeling about massive unemployment in Scotland and the inadequacy of the job creation programme I would suggest that these are excellent reasons for delay as these measures will have detrimental effects. They will mean more public expenditure, more taxation, and probably a deterioration in service, because contrary to what the Secretary of State has suggested I cannot help believing that many people who are using the private health service will opt for the National Health Service, and thus waiting lists wil become longer.
The British Medical Association, Lothian Branch, said in Edinburgh that the concept of complete separation of private medicine and the National Health Service was quite alien to the willingness of consultants to discuss NHS problems at all times, both in private consulting rooms and at all other times when they were available in hospitals to deal with NHS patients. Clearly the hon. Member for Preston, South would like to see the end of part-time consultancy. But he is at loggerheads with the Secretary of State because part-time consultancy is safeguarded in this Bill. This upheaval in making part-time consultants less readily available to deal with NHS patients could lead to a deterioration in services.
I think that it was Nye Bevan who said that the language of priorities was the religion of Socialism. In looking at these priorities we should bear in mind what the Chairman of the Scottish General Medical Services Committee of the BMA wrote recently:
We consider that the Act as tabled could be used to create a monopoly by the State of health care provisions in Scotland—perhaps not now, but at a future date. This Bill

cannot do anything but harm to the people of Scotland and the Health Services which they receive.
For these reasons postponement of the Bill can do nothing but good.

5.45 p.m.

Mr. Ron Thomas: I welcome the opportunity to speak in favour of New Clause 2 and I very much hope that it will be carried. I hope that the Government have had second thoughts, and that when the Minister replies he will accept the new clause.
I was not a member of the Committee on this Bill but I have listened with interest to those who were. As far as public expenditure is concerned, this argument has been exposed by my hon. Friend the Member for Preston, South (Mr. Thorne). However, I, too, emphasise that I doubt very much whether there has been any increase in real terms, if we take out the cost of reorganisation of the NHS and of local government, in the provision of resources for these two areas of public expenditure.
On many occasions I have tried to get information from the Secretaries of State concerned about the kind of index or indices they use to arrive at decisions on increases in real terms. It is no good taking the index of retail prices because, in particular, part of the NHS increased prices or commodities, including expenditure on capital equipment and so on, differs very much from the simple index of retail prices. I doubt whether there has been any increase at all in real terms.
My hon. Friend the Member for Preston, South is right to emphasise that the Tories continue to insist on cuts in public expenditure of anything between £5 billion and £10 billion. They keep on about this continually, but whenever attempts are made to pin them down on the particular services which they would cut—the social services and social workers, the National Health Service or education—they shy away from making any clear commitment or decision. The Shadow Chancellor keeps saying that he would look at each one of these items.
I hope that there are very few Members of the House who continue to support the abhorrent and even obscene practice of queue-jumping. We all have constituents who come to us and say that they have been to their doctors


and have found that they are suffering from a whole range of serious or painful complaints. They are told that, while they cannot get into a National Health Service bed for two or three years, if they can pay they can get into a private bed next week. Can anyone in this House support that kind of system? Bed availability should be based clearly on the need for medical treatment and not on whether a patient can afford to buy private or quasi-private facilities.
It is no longer the case that only individuals are buying these private facilities. It is firms up and down the country which are buying them for their managers, executives and others whom they wish to keep out of trade unions—their selected few. And it is the consumer of their products who pays for the bed. One gets the impression that many managers and directors go into hospital for a week to recover after having many heavy business lunches or a night out on the binge. This is becoming a growth industry—it is about the only one we have. One has only to see the advertisements from BUPA which are aimed at companies. They say "Protect your manager and protect your executives." This is so that these people can hop in and out of hospital when it pleases them.
Another appalling part of this is, in my judgment, that there would be no private health services whatsoever if there was no NHS. It is because private medicine uses the facilities of the NHS, the back-up services and the expensive capital equipment, that it can survive for one minute.
I was employed at a university, and I wonder what the ratepayers would have thought if I, in my capacity as a lecturer at the university, had said that I was going to select one or two of my students and use the facilities of the university to give them private coaching—they would be paying me, of course—in an attempt to get them a first-class honours degree.

Mr. Robert Kilroy-Silk: My hon. Friend is quite right to point out that a lot of the NHS facilities are used for private medicine, but it goes much further than that. A report of this House shows that there have been serious allegations of consultants mis-

appropriating machinery, equipment and facilities from NHS hospitals for use outside in their private clinics.

Mr. Thomas: My hon. Friend is quite right. That is a further indictment of the system. My own union, ASTMS, which has many members in the National Health Service, continually complains about this kind of situation where public resources are used for private profit. Why stop with the NHS? Why should not firemen select the fires they go to, or police select the break-ins they attend, and keep a few on the side to deal with privately in order to add to their incomes? One could go on giving such examples ad nauseam.
Lord Goodman has been mentioned in the debate. Many of us are becoming worried about the influence he seems to have over legislation. Apart from this Bill, he came up with a compromise on the Trade Union and Labour Relations Act. We wonder what will come next. I do not know whether there is any truth in the rumour that he may be heading some kind of national Government. That is always a possibility.
Many Labour Members are concerned that the Bill will give legislative respectability to the growth of private medicine in Britain. We fear that it will enshrine in legislation the principle that there should be a private sector. We talk about attempting to control that private sector, but many of my hon. Friends and I maintain that we are not in politics or in the Labour Party to foster a private sector for medicine. We ask my right hon. Friend the Secretary of State once again to reconsider this provision, because many of us feel unable to support legislation which clearly states for the first time that the principle of a private sector in medicine should be supported and that it will be supervised in some vague way.

Mr. David Crouch: We never ignore the passion which comes from Labour Members sitting below the Gangway. It is obviously seriously meant, even if sometimes, as was the case with the speech by the hon. Member for Bristol, North-West (Mr. Thomas), it seems to make nonsense of the actions of those who are trying to help the National Health Service. Nevertheless, I understand the passion that lies behind devoted Socialists in these matters.
No one in this House is prepared to support queue-jumping, but it seems that members of the Tribune Group believe that they are the only ones who can argue passionately against it and take opposition to it as their creed. That is where they are wrong.
Let me now deal with the Secretary of State. I pay him the compliment of saying that it is very pleasant to make a speech from the Back Benches and to find the Secretary of State still in his place. Without robbing him of any dignity or status, I must say that it is equally pleasant to see his predecessor the right hon. Member for Blackburn (Mrs. Castle) sitting two rows behind him. The Bill has a great deal to do with both the right hon. Lady and the Secretary of State.
I have to stop and think where I am when I hear an hon. Member as responsible as the hon. Member for Brent, South (Mr. Pavitt) putting forward the arguments we heard this afternoon when he introduced the new clause. It has nothing to do with the basic intentions of the Bill as originally devised and presented to the House by the right hon. Lady. To use an old-fashioned word, I believe that the hon. Member for Brent, South is trying to hornswoggle us. That word, which dates from the 1920s, means to practise a form of deception. It is perfectly parliamentary and respectable and it describes exactly the hon. Member's actions today. He is trying to overturn three months' work in Committee upstairs. The Committee engaged in serious discussion extending over 28 sittings, but in spite of that discussion the hon. Member has introduced a clause which seeks to hustle the House into doing something which was not agreed upstairs.
The hon. Member is perfectly entitled to produce a new clause on Report, but his proposal today is not in line with the right hon. Lady's intentions. She underwent great trials before she brought the Bill before the House and argued it so forcibly. She had to accept the compromise put forward by Lord Goodman on 15th December. I do not think she liked that compromise, but she is a sufficiently distinguished parliamentarian to do so. She said in the House in April this year, in describing how far she had been prepared to go in meeting the arguments

of the doctors, and particularly the consultants, about the phasing out of pay beds, that she had accepted Lord Good-man's proposals. She added
There is in this legislation the essence of a reasonable compromise".—[Official Report, 27th April, 1976; Vol. 910, c. 242.]
At the end of her speech, the right hon. Lady reminded the new Secretary of State in very strong language that he should not go any further down the line of compromise suggested by Lord Goodman. She said that she would be watching him every inch of the way in Committee, in the House and elsewhere. It was the Secretary of State's first week in office, and her action was an interesting reminder of the power of former Ministers and of Back Benchers.
The right hon. Lady did not suggest that she would renege on her agreement with Lord Goodman. The hon. Member for Brent, South, however, is saying that he is dissatisfied with what was done in Committee. He said today that he had studied the early proceedings in Committee, and he referred to there being 3,500 beds in question. The figure is not as high as that, but, whatever might be the residue of beds to be phased out by agreement under the Goodman proposals, the hon. Gentleman is not satisfied with the arrangement. He wants matters hustled forward. The Government are being asked to forget the responsible delay which was built in during the long discussions and negotiations with the consultants.
I am concerned that the new clause is not only contrary to what the House intended when it voted for the Bill on Second Reading but is not what the House and the public understood the Bill to provide. The Secretary of State never intended that these 3,500 extra beds should be hustled out of the National Health Service. That was not what the former Minister of State intended when he spoke in Committee about his intention to create peace again in the service. To hustle these beds out now without further consultation, or without enough consultation, would not be a step towards creating peace in the service.

6.0 p.m.

Mr. Ennals: Surely part of the purpose of Report stage is to give Members who are not satisfied with what has


happened in Committee the opportunity of putting forward their proposals. If it were to be suggested that we should not now be discussing anything which was not intended when the Bill first came to the House, I should have to say that almost all the Opposition's amendments should be withdrawn. I suppose that that would be satisfactory in that we could finish by supper time.

Mr. Crouch: In a way, I stand corrected by the Secretary of State. If I gave the impression that I do not think it right to bring forward amendments and new clauses on Report, I stand corrected. I do not object to that being done, but we are having a debate about a legitimate parliamentary procedure for bringing forward a new proposal. It is a different proposal from that which is written into the Bill. It is a different idea from that originally suggested by the former Secretary of State and agreed with the consultants, using Lord Goodman as an intermediary.
In the early days of the proceedings in Committee, the former Minister of State said:
The limitation that the Bill imposes on the Secretary of State is that he can phase out no more than 1,000 beds, and that this power should be exercised within six months of Royal Assent.
A little later he said:
Where the Secretary of State is circumscribed under this legislation is that within any area health authority he cannot take out any more beds than are within the schedule. There is that limitation."—[Official Report, Standing Committee D, 18th May 1976; cc. 26–27.]
That was accepted at the time by Labour Members. That is how we understood the Bill was to proceed. Now it is proposed that something entirely different should be added. I have described it as a hustling measure. My right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin) has spoken to New Clause 4, which tries to do the very opposite.
The House knows that I work in the National Health Service as one of those much-disliked persons have have been appointed or nominated by the Secretary of State. My nomination was not cancelled by the right hon. Member for Blackburn. Indeed, it has recently been

reinforced by the present Secretary of State.

Mr. Ron Thomas: My right hon. Friend the Member for Blackburn (Mrs. Castle) is a member of the Tribune Group.

Mr. Crouch: The right hon. Lady does not make mistakes like that. She must have liked me. At least, I hope she did. I have not yet said anything unkind about her. I have not even said that she has hornswoggled me.
My right hon. Friend the Member for Wanstead and Woodford, in speaking on New Clause 4, left me with the understanding that his objectives are entirely the same as those of the former Minister of State. The right hon. Gentleman wanted, as I want, to see peace established again within the service. In fact, we are getting very nearly back to peace in the National Health Service. I am talking not only about consultants but about all those who work in the service.
The proposal contained within the new clause is very different from the intentions of the Bill. The clause seeks to hustle something through at the last minute. That attempt is made during the last stages of the Bill's progress through Parliament. I believe that it could do incredible harm in disturbing peace in the service. It would be seen by those within the service not as a legitimate parliamentary device but as something that is wrong, and even a deception. They would see it as a breaking of the word that was given at an earlier stage.
Above all, we need time for the contentious proposals that lie behind the Bill itself to be received and for a settling-down period. I am not seeking to scrap the whole proposal contained in the Bill, although I do not like the idea of removing some 4,000 or so pay beds from the 500,000 beds within the service.
I have always said—I said it on Second Reading—that the Bill will have a disruptive effect within the service. I have said that it could be positively harmful to our already disturbed service. I do not believe that the addition of 1,000 beds, or even 4,000, will help the waiting list problem. I recognise that this problem will have to be considered. I admit that I say this from a position that is


many times removed from that which is occupied by many of those in the service—namely, as an administrator in a regional health authority.
Quite honestly, the addition of 113 beds in the region where I work would not make any difference. It would be a drop in the bucket. I can understand that some people think it will have a psychological effect, but I am talking about the real effect. At this stage, 1,000 beds are what might be termed peanuts. There are many more things that have to be done in the service. Indeed, the NHS is about to undergo its greatest trial of all—namely, the real cuts now being imposed on it.
We must recognise that the cuts are now operating. It is not right for anyone to suggest that the cash limits are not yet being applied throughout the service. The directive has come from the Secretary of State. He means business. However, after a few more Cabinet meetings I am certain that he will be given still further cash cuts to make in the service. Those of us who work in it dread the day when we have to implement those cuts. We dread what they will mean. That is a trial that the service will have to go through in the next few months, and perhaps over the next two or three years.
All those who work in the service, whether nominated persons such as myself who sit at the top of a region or consultants, nurses, ancillary workers and porters, will be fighting to continue to give the type of service that is now being given. The NHS will be attempting to offer the same service but with less money.
There is a great feeling of service within the NHS. Maybe there are disputes involving the unions, the junior doctors, the consultants, the nurses and the ambulance men, but collectively there is the greatest possible harmony when it comes to giving a service leading to the cure and the care of the sick and the ill. I have nothing but the greatest admiration for that harmony. It should be made to exist in a health centre, in a hospital or throughout an area or district. All our energies must now be directed towards saving the service and continuing to give a service to those who are sick or ill.
We shall need every penny we can get if we are to be able to continue with the service. This is no time to rob the NHS by taking money out of the service to satisfy—

Mr. Leslie Spriggs (St. Helens): The hon. Gentleman is speaking as a selected or nominated member of a regional board. Has he ever considered the feelings of those who are suffering illness and who have been on a waiting list for two to three years? What have the hon. Gentleman and his committee done about those cases?

Mr. Crouch: I accept that. On many occasions constituents have come to me with that sort of problem. There is a way of dealing with it apart from rushing to the Press and saying "This is disgraceful". There are instances when people have to wait two years for a hip operation. It is often necessary to wait that long for what are described as non-acute operations, although they probably are acute when people cannot sleep because of the pain. However, it is possible for a Member to do something. [Interruption.] Perhaps I might be allowed to continue as I know that the hon. Member for Wolverhampton, North-East (Mrs. Short) likes to hear me occasionally.
If someone comes to me to tell me that he has waited two years for an operation, the reason is usually that the consultant he is attending has a number of beds in one or two hospitals where he is a consultant and where, perhaps, there is a crowd. If one gets to work on the service through the areas and districts, one can usually find a vacancy in another hospital. Time and again I have succeeded in getting people placed in another hospital well outside their original area—I do not mean in a pay bed, but in a National Health Service bed. Hon. Members can help people to get service in the NHS. That is what we are meant to do, and those working in the service must also try to help in that way. Instead of getting so much publicity about problems, they should try to help people to get the services they desperately need.
I recently stopped for petrol in my constituency on the road to Margate, and the attendant reminded me that some years ago I helped him to get into hospital for


a hip operation. I suggested that he should try at a different hospital, and he was admitted within six weeks. This sort of thing is possible. I know because I have done it.
I believe in private beds because some illnesses require privacy. There are private beds—not amenity beds—in the National Health Service for all types of illness where a person is judged to need special privacy. A friend of mine suffered a severe stroke recently and was admitted to Guy's Hospital, which I know well. I expected to find him in a public ward, but it was thought that his case deserved the privacy of his own room and he was in a private room much better than any of the private beds I have seen at Guy's Hospital. I am delighted that the NHS can provide such services. I would be the first to support an increase in these private facilities.
At this desperate time for our country, we should be considering the real problems we face in the care of the sick and not the sort of problem thrown up by a Bill which has been before the House for four or five months.
We should be doing something about our out-of-date acute hospitals and their old-fashioned equipment. We should be doing something about the lack of accident centres which means that a person seriously injured in a road accident may have to be driven up to 30 miles to hospital in an ambulance. It is good that people are taken to a hospital with the best facilities, but sometimes the distance is too great. There are not enough acute accident centres.
We should be looking at the awful problem in our psychiatric hospitals. We cannot hustle this problem and get rid of it in a year or two, but we should be putting pressure on the Government and the NHS to give priority in this direction.
I do not regard my job on the regional board as simply to check the figures presented to us. My job is to get out into the hospitals and health centres and meet the doctors and patients. Sometimes it is disturbing to spend a whole day in a hospital for the mentally handicapped or, as the Secretary of State did recently in my constituency, at a hospital for the mentally ill. We should be thinking of

the need to spend money for the rehabilitation of many mentally handicapped patients into society.
I have seen hospitals where the only X-ray equipment available was 20 years old and out of date. I have seen operating theatres where it is almost impossible to keep out sepsis. It is amazing what operating teams manage to achieve in them. I have seen operating theatres set up in wooden huts that were built in 1916.
There is a great lack of brain scanners in this country. When I asked at Guy's Hospital, I was told that there was no brain scanner there. The last scanner I saw was in Saudi Arabia, where there was also a full body scanner. We do not have enough facilities for kidney transplant operations. We do not have the necessary back-up or enough nursing staff or operating teams, let alone enough principal surgeons trained to do the operations.
6.15 p.m.
These are the sort of problems which should be concerning us now. Not only is it wrong to change the nature of the Bill as is proposed by New Clause 2, but the Bill has now become a greater waste of time than it was before. There is so much more for us to do here. The Bill does not deserve to be passed by Parliament. It should be put on ice, and I suggest that the House should accept the reasonable proposal in New Clause 4. Let us give it pause.

ROYAL ASSENT

Mr. Deputy Speaker: Before I call the next hon. Member I have to notify the House, in accordance with the Royal Assent Act 1967, that the Queen has signified Her Royal Assent to the following Acts:

1. Stock Exchange (Completion of Bargains) Act 1976
2. Parliamentary and Other Pensions and Salaries Act 1976
3. Great Northern London Cemetery Act 1976
4. Greater London Council (Money) Act 1976

HEALTH SERVICES BILL

Question again proposed, That the clause be read a Second time.

Mrs. Barbara Castle: It is refreshing to have had so many new participants in this debate. When a small number of people are closetted together in Standing Committee day in and day out, week after week, they tend to develop a slightly incestuous political relationship. When the hon. Member for Somerset, North (Mr. Dean) gives us his familiar and hackneyed line that the Government have not made out the case for this Bill, it merely shows that during the long period in Committee he was not listening. I am glad that more of my hon. Friends are here for this debate and that there are also fresh faces opposite. It is right that we should widen the debate to bring these arguments to the public's attention.
I totally accept the right of my 80 hon. Friends to table New Clause 2. They are exercising the parliamentary rights to which the Opposition also have been laying claim by seeking to amend the Goodman proposals and compromise but in exactly the opposite way. That is what they are doing in New Clause 4, which is also a direct violation of the Goodman proposals. It is beyond me to understand how the hon. Member for Canterbury (Mr. Crouch) can lecture us on the need to stand by the Goodman proposals and end his speech by asking us to vote for New Clause 4. He cannot have read the Goodman proposals or he would not be advocating the acceptance of that clause.
I have enormous sympathy with my hon. Friends and I stand here subject to very severe temptation. I understand exactly their anxiety and their aim. Our aim and our goal are the same. I accept the analysis of my hon. Friend the Member for Brent, South (Mr. Pavitt) in which he pointed out the obscenity of queue-jumping. Abolition of queue-jumping has always inspired us on these benches and it made us the real architects of the NHS which is always being sniped at and undermined by the Opposition.
The existence of private beds within what is aptly named the National Health Service is a violation of the concept on which that service was built. The fact

that Nye Bevan had to make a temporary accommodation, contrary not only to his principle but the principle of the very service that he was creating, does not prove anything to the contrary.
One important part of this legislation is the principle of phasing out which is embodied in the Bill. I hope that there will not go out from this House any suggestion that this legislation authorises the indefinite continuation of pay beds in NHS hospitals.
This is set out in the terms of reference of the independent board which is to be set up. The Goodman proposals—if they had not contained this proposal, I should not have been a party to accepting them—in paragraph 2 state:
The legislation would contain first a broad declaration that private beds and facilities should be separated from the NHS.
That declaration of principle has been embodied in Clause 2(1) of the Bill. We had a lengthy discussion about it in Committee simply because it is unique to embody a declaration of principle in legislation like this.
Therefore, there is no difference of principle between me and my hon. Friends on the urgent need for phasing out pay beds from National Health Service hospitals.
We have had a number of specious arguments to the contrary from the Opposition. We have been told—the hon. Member for Canterbury dilated on this aspect at some length—that the handing over of pay beds to the NHS will not make any difference to the waiting lists. What the Opposition fail to understand is that there is a built-in commercial incentive, even to the most high-minded consultant, not to be entirely wholehearted about dealing with the problem of waiting lists. Of course, there is the element of the lack of resources in this problem, but there is also the question of management. If it pays somebody not to get his patients to the top of the waiting list, because they will then have to go privately and pay him instead, how can we expect an enthusiastic attempt to tackle the problem of waiting lists?
Hon. Gentlemen opposite said that they were in favour of common waiting lists and that, if we had put forward proposals along those lines, we could have had an agreed measure. Again, they


are listening only to what they want to hear. I have explained many times, as has my right hon. Friend the Secretary of State and his former Minister of State, that we have tried to get agreement on common waiting lists. The first proposition that we put to the medical profession to deal with the problem of queue-jumping was that we should have one common waiting list under which all patients, whether NHS or private, would be dealt with strictly in order of medical priority. That was rejected as a piece of arrant Socialism. Of course it is, but it was intended as such.
We must get this matter straight on the record. When I was at the Department this proposal was debated at a representative meeting of the consultants and a motion was put forward in the name of East Kent:
That this meeting rejects any proposal for a common waiting list for admission to public and private wards in the National Health Service.
That motion was accepted with acclamation. Dr. Astley, the chairman of the CCHMS, the consultants' negotiating body with which we were negotiating, made a great speech which was reported in the British Medical Journal. I will send a copy to anybody who wants it. It said:
Dr. Astley, referring again to the common waiting list, explained the notion of queue-jumping as being one of the reasons why pay beds should be abolished. It was said it was morally dishonest that people should get a bed more quickly simply because they were prepared to pay for it. Mrs. Barbara Castle had suggested a system of a common waiting list: Mrs. Castle had also closed some 450 so-called under-utilised pay beds. His committee had no sympathy for the common waiting list: in its view, pay beds were part of a mixed economy. Britain was, after all, still a capitalist country, and the committee would refuse to have anything to do with common waiting lists.
Let us get that clear once and for all. That was the official spokesman for the consultants, and that view has not been altered.
I know that my hon. Friends have many anxieties about the Goodman proposals. I should like to refer them to another important achievement. As part of the agreed package we have got accpetance by the medical profession that one of the first tasks of the board should be to examine the possibility of common waiting lists.

Perhaps we can inch our way forward towards a better understanding of each other's needs in our relationship with the medical profession. We cannot run the health service in a state of total war. Therefore, we need to make advances where we can and let light break through.
I hoped that the Opposition would say that they welcome this reference in the Goodman proposals to the need to examine the possibility of establishing a common waiting list and that it ought to have been done years ago. That is what they should be saying, but, on the contrary, they have tried to pretend that it was always acceptable to the profession. I have proved that it was not.
A further specious argument they have called in aid is the economic crisis. We are told "It is the wrong time." It was also the wrong time, in the view of the Conservative Party, to set up the National Health Service in 1946. It is always the wrong time. That was a time of great economic difficulty. The post-war Labour Government were struggling with one economic crisis after another. Yet, looking back, who will deny that, by establishing the NHS in 1946, we produced what the Prime Minister has called "social cohesion" to an extent not achieved before? If we had not done it in the post-war years we should have had a far more violent history in the post-war period.
The same argument applies now. At a time when we are telling everybody that we must all tighten our belts, we cannot say that some people must tighten their belts more than others. I find it nauseating when Members of the Conservative Party, whose supporters can afford everything from private yachts to private aeroplanes to fly dogs over the Atlantic, lecture us about the need to tighten our belts and say we cannot afford to abolish queue-jumping.
6.30 p.m.
It is also hypocrisy for Opposition Members to pretend that if they were returned to power they would insulate the NHS from further cuts. It must be hypocrisy. The Shadow Chancellor told us only yesterday that he wants £4 billion more cut from public expenditure. At the Conservative Party conference a resolution was passed to the effect that every Government Department must make its contribution to cuts, with the exceptions only of defence, the police,


and what the Conservatives called "those in need". How does one identify those in need in the NHS? It is not operated by a means test. Do the Conservatives mean that they will operate a means test? It is impossible to cut £4 billion from public spending without making savage inroads into the NHS along with everything else.
Of course I believe in my consultative document. I would not have put it forward otherwise. However, in the very hectic discussions and consultations that went on it was strongly urged upon me that the adoption of this alternative way of handling the principle of phasing out—I repeat that that principle remains—would produce a cessation of the worst tension and hostilities. Having argued and negotiated over every single word—every word has its meaning and its opportunity—I accepted the proposals and put them to the House.
On this matter the Government have kept all of their promises. There was fullest consultation, as promised. There has been the fullest and most exhaustive debate at all stages of the Bill. The Bill contains full Goodman, and nothing else. The Opposition have never played it straight, like that. They want the bits of Goodman that suit them. They lecture us if my hon. Friends put down amendments to amend Goodman, and then put down amendments of their own that would fundamentally wreck the compromise.
I have been gravely concerned tonight about how I should vote. If I thought that the Bill retained pay beds indefinitely I should be going through the Lobby with my hon. Friends, because that is not the compromise that I negotiated. If that is what the right hon. Member for Wan-stead and Woodford (Mr. Jenkin) thought the Bill would do he would not he attacking the Bill as vigorously as he is; nor would the medical profession. That is the proof that is needed.
The Bill does not contain a final date, but it contains criteria of operation for the independent board which will in due course give us finality. In answer to the hon. Member for Canterbury, I do not call the three and a half years which my hon. Friends visualise a "hustle". Let us all meet again in three and a half years' time. Some of my hon. Friends

may be surprised at what we achieve when the Bill becomes law. Let us remember that not only do 1,000 beds go out on the Secretary of State's schedule within six months of the first date, but during the first six months after the passing of the Act the board is under an obligation to review the pay bed situation in the light of the criteria and to produce recommendations for further phasing out, and it must do so regularly at six-monthly intervals, of which there are seven in three and a half years. If the board has not made recommendaitons for phasing out at any stage, it will have to explain to the House why.
If we find that the Bill is not working, we can move in again. My hon. Friend the Member for Brent, South may be surprised to find that my compromise might prove to be a faster hare than his New Clause 2 snail, for all I know. It is a matter for the independent board, which will be a balanced body, to decide. I stand by the compromise because it was a sincere effort to bring industrial peace to the NHS.
I issue a warning. It is not addressed to my right hon. Friend the Secretary of State, who has, with one or two small exceptions where I disagree with him, stuck firmly to the compromise agreement reached and has not reneged on it. My warning is to another place. If this compromise is to be challenged and injured in another place and if Lord Goodman does not carry out his part of the bargain and tell their Lordships that this was negotiated to bring peace to the NHS, there will be no peace in the NHS. Their Lordships will have reopened the gates for industrial action, and it will be upon their own heads, because this is an attempt to heal old wounds and allow the NHS to revert to its true original principles.
My hon. Friends have my heart but not my head.

Mr. Cyril Smith: The right hon. Member for Blackburn (Mrs. Castle) referred to the obscenity of queue-jumping. I certainly go along with her in her description of queue-jumping. I also go along with her in her plea for peace in the NHS. I found it a little difficult to reconcile her plea for peace with her attack on the consultants when she virtually accused them of deliberately


keeping waiting lists long in order that they could take private patients and draw money from them. I find it a little difficult to balance the plea for peace with that sort of statement.
I listened to the speech of the hon. Member for Bristol, North-West (Mr. Thomas). I felt that someone should educate him and explain to him matters such as private tuition, private detective agencies and even private fire brigades, of which obviously he has never heard in his whole experience.
I do not go along with the Conservative Party's political strategy as expressed in terms of the economic debate on Monday. Where I was last night was no accident. I do not go along with trying to force a General Election for political ends and selling the country short in the process. [AN HON. MEMBER: "What is your majority?"] It is sufficient to give me confidence about the next General Election should I decide to take part in it.
However, although I do not go along with Conservative economic strategy, I believe that the Conservative Party is right in describing this Bill as irrelevant to the country's present economic situation and irrelevant at this moment in our history. I have always taken the view that health services should be available on the basis of need rather than the basis of wealth—although doubt has been expressed by at least one Labour Member today as to whether one can assess need in terms of the NHS. However, I have always felt that the service should be available on the basis of medical need.
Incidentally, I also take the view, which should not be overlooked, that members of schemes like BUPA which have been attacked—I am not a member of any private health schemes at all—pay their NHS contributions as well. [An HON. MEMBER: "They have to."] Not always, but in most cases, yes. All I am saying is that this ought not to be overlooked in the argument.
I believe that the surest way of stopping people jumping the queue is to abolish the queue. I very much doubt whether the Bill will do anything material—possibly it will do something minor—to affect the long waiting lists which exist

for particular skills in the medical field. One thing I am certain of is that we will not reduce the size of waiting lists by creating an atmosphere which encourages consultants and doctors to emigrate. I am certain that we will not reduce the waiting lists in that way.
I have talked to dozens of consultants about the Bill. It is no secret that Rochdale has not been the happiest area in terms of the reorganised National Health Service. Indeed, on more than one occasion I have presided at committees of trade unions such as NUPE and CoHSE and consultants and doctors to try to get a bit of peace into the local scene. Indeed, a colleague of the right hon. Member for Blackburn at the Department of Health and Social Security thanked me personally for the efforts I made in regard to conciliation in those troubled days.
Having talked to consultants, my view is that they are not desperately worried about pay beds. What they are worried about is the political implication behind the abolition of pay beds. Having listened to more than one Labour Member below the Gangway this afternoon, I get the view that the consultants' fears are based on fact. The consultants are not desperately worried about the abolition of pay beds. What they are worried about is whether they are to be allowed to continue with matters such as private patients, private medicine and so on. There have been Members on the Benches opposite, not members of the Government, who this afternoon have virtually indicated that they wish to abolish private medicine. That is what is upsetting the consultants, not the abolition of pay beds. Perhaps the fears of consultants, who have been attacked, are based on fact rather than fiction and on the fact that they have cause for concern and worry.
While I have really no objection to the abolition of pay beds, I object to any step which pushes us a little further along the road of taking away private choice. Labour Members say that they object to private medicine, but the Bill does not abolish private medicine. Labour Members below the Gangway are making speeches about what they want to achieve and are using the Bill as a means to an end, but not as an end in itself. It is


for that very reason that my colleagues and I will vote against New Clause 2 and in favour of New Clause 4.

6.45 p.m.

Miss Jo Richardson: I was interested, as I am sure we all were, in the remarks of the hon. Member for Rochdale (Mr. Smith). I can assure him that a large number of hon. Members on this side—I include myself among them—would have liked the Bill to phase out private practice altogether. We were not successful, but that is not to say we will not go on and perhaps at some future date achieve what we want to do.
I should like to refer to one of the remarks made by the hon. Member for Canterbury (Mr. Crouch) in response to an intervention put to him by my hon. Friend the Member for St. Helens (Mr. Spriggs). In his response, the hon. Member for Canterbury was at great pains to admit that because there were waiting lists some people were disadvantaged and that he as a public representative—as we all are as Members of Parliament—was from time to time faced with constituents and others who needed help to get into hospitals and get treatment which they deserve and which is their right.
The hon. Gentleman made great play, as I recall, of the fact that he had been able, as we all have been on some occasions, to get people into hospital perhaps not in their own areas but a long way away. That is not the kind of health service we want. We do not want to have to search around miles away from the homes of people who are sick to find places for them because there is no space in a hospital which is nearer their homes.

Mr. Eddie Loyden: That entails visiting.

Miss Richardson: My hon. Friend refers to visiting, and that is a problem. We want to see waiting lists as short as possible in every hospital and that all patients under the NHS have the opportunity of getting into the hospital which is nearest to them as quickly as possible.

Mr. Percy Grieve (Solihull): I have listened with interest to what the hon. Lady has said. How does she think that the complete abolition of private medicine, which will drive freedom-

loving doctors away from this country, will shorten the waiting lists of patients?

Miss Richardson: I am grateful for that intervention. I intended to come to that a little later, but perhaps I may deal with it now. I believe that there are something like 25,000 beds in the private sector of medicine which are not operated by the National Health Service and which, therefore, are not the subject of the Bill. As I understand it, there are some 29 private hospitals for which planning permission has been given and that a similar number in the pipeline have not yet reached that stage.
The hon. and learned Member for Solihull (Mr. Grieve) says that all good doctors would flee the country. [HON. MEMBERS: "Freedom-loving."] I beg pardon. I should have said that all the freedom-loving doctors would flee the country. I do not happen to have the same view of doctors as the hon. and learned Gentleman seems to have. I believe that a very large number of doctors in this country are dedicated to the NHS and would not take that sort of freedom-loving flight to another country or take their talents elsewhere.
Throughout the passage of the Bill we have seen the Government hamstrung by the Goodman proposals because, in my view and in the view of a number of my hon. Friends, the Bill is not the Bill which we would have had if Lord Goodman had not, as it were, interfered. On the one side, we have therefore had the Government hamstrung by the Bill with the Goodman principles and proposals injected into it. On the other side, we have had the Opposition doing everything they could during the passage of the Bill, particularly in Committee, to give the Goodman proposals even more of a nudge in the direction of favouring the retention of private beds and enhancing the opportunities for private practice. Some of us on this side tried in Committee—alas, without success—to inject some of the original proposals back into the Bill. This is why we support New Clause 2.
Much has been said, sonic of it jocularly, to this effect: "If private beds, why not private other things?" One can think seriously about this. A number of instances have been given. All hon. Members would blanch at the thought that


we might go back to private electricity companies, gas companies, water companies or telephone companies, or at the thought that some people might get extra private benefits by paying a little more in national insurance contributions.
We must get away from the idea that paying privately should give someone a privilege. I believe that all of us on this side believe that a National—like my right hon. Friend the Member for Blackburn (Mrs. Castle), I stress that word—Health Service entitles everyone to a free and comprehensive service and that it is the existence of the principle of pay beds within that service to which we object and which we want phased out as quickly as possible.
It has been said that under the Bill as it stands the Secretary of State will phase out the first 1,000 beds. Of course, I accept absolutely that the Government want the remainder of the beds phased out as soon as possible too. But the consultants, the BMA and the Opposition, may—I am sure they will—take the totally different point of view that the time should be extended. That is why my hon. Friends and I would prefer a safeguard to be written into the Bill by means of a time limit for phasing out the remaining beds.
There have been several references tonight to the late Nye Bevan. Many of us remember the bitterness he felt when he felt forced, as he said himself, to stuff the consultants' mouths with gold in order to get acceptance of the principle of a free health service for the majority of the people. I think he had hoped that not too long after the passage of his Bill, and certainly not long after his unfortunate death, pay beds would begin to be phased out. It is now nearly 30 years since that Bill was brought in, and he must be turning in his grave at the thought that we are still resisting their final phasing out.

Mr. Pavitt: May I remind my hon. Friend that in his book "In Place of Fear", written in 1951, Nye Bevan made it explicit that he thought that within a few years the pay beds would be phased out?

Miss Richardson: That is the point I am trying to make. I am absolutely sure that if Nye Bevan came back now he would be taken aback at the thought

that we still have not phased out pay beds.
I repeat that some of us make no secret of the fact that we would have preferred a Bill not simply to separate private practice and allow it to flower in a private sector but to phase out all private practice altogether. But that is not to be. I do not expect the Opposition to support New Clause 2, but I would have hoped that the Government would seriously consider its intentions. It is not that we disbelieve the Secretary of State. We believe that he hopes and desires that these beds will be phased out. It is simply that we do not trust the other fellows. We want to make sure that the phasing out is spelt out in a way that no one can circumvent. That is why I hope that the Government will have a rethink and support New Clause 2 as well.

Sir George Young: One cannot but feel sorry for the Secretary of State, who has sat there throughout the debate waiting for one favourable speech from his colleagues supporting the Government's policy. With the exception—it was only just an exception—of the right hon. Member for Blackburn (Mrs. Castle), not one Labour Member is prepared to support the Government's policy. Perhaps the Whips could find one Labour Back Bencher in the Tea Room who is prepared to come here and defend what the Government are doing. It might be a courtesy to the House if they could also find the mover and seconder of sub-amendments (a) and (b).
In his speech yesterday the Prime Minister said that when our standards were changing in many ways and there were different values it was important not to stretch what he described as "ideologically pure remedies". Yet the very next piece of legislation that he brings forward is the purest and most irrelevant piece of Socialist idealogy of the whole Session—namely, this Bill.
The Bill is totally irrelevant to the fundamental problems of the National Health Service at the moment. The Prime Minister went on to say that
the sensible policy for this Government—and. indeed, for this country—to pursue is to work on a constanty diminishing percentage of the public sector borrowing requirement as a percentage of the gross domestic product, and to work it down over the next two to three years."—[Official Report, 11th October 1976; Vol. 917, c. 162.]


If the House does not adopt New Clause 4 the Bill will do the opposite: it will increase public expenditure by up to £20 million by 1980.
Earlier yesterday the Chancellor of the Exchequer said:
We have always insisted that export demand must be the main foundation of our recovery".
He referred to it as
one of the basic objectives of the Government's economic strategy."—[Official Report, 11th October, 1976; Vol. 917, c. 40.]
Without New Clause 4 the Bill will hit our exports by making it more difficult for the medical profession to earn valuable foreign currency by treating overseas patients. The only export which will be accelerated by the Bill is the export of skilled medical practitioners whom we can ill afford to lose.
Therefore, by their own standards, the Government's economic and social objectives are totally in conflict with the Bill. That is why we believe that New Clause 4 should be accepted and the implementation of the Bill delayed.
The Government should recognise that circumstances have now changed. The Bill was conceived two years ago in totally different economic conditions. The money which they have had to allocate towards phasing out the beds is now desperately needed to maintain services in the NHS. A Bill like this can be introduced only in the context of economic growth. To try to introduce it in the context of recession and a cut in services is political lunacy.
I would amplify that statement by reference to my own constituency. The Secretary of State has directed the Ealing, Hammersmith and Hounslow Area Health Authority to balance its books by the end of the current financial year. That authority now proposes the closure of three hospitals, one home of recovery and one chest clinic, and a reduction of services at three other hospitals, including Acton Hospital, one TB hostel and one drug dependency unit.
It is nonsense for the Secretary of State to say that he will release private pay beds to the NHS by this Bill when the NHS cannot maintain those that it already has and is closing them down. On top of the cuts which affect services to constituents, jobs will be left vacant,

expenditure on equipment will fall, agency staff will be eliminated and overtime will be cut back. Even so, the authorities will not be able to comply with the Secretary of State's directive to balance the books this year.
7.0 p.m.
Does the Secretary of State believe that constituents will accept the cuts because he says that part of the money is needed to phase out pay beds? The priority of the people is to have services maintained, rather than cut to get the Bill through. The Government are not alive to the political realities of the Bill and people will equate the cuts in health service expenditure with the Bill.
Postponing Part II till December 1978 will give the Government time to answer a question which I asked on Second Reading. Who will benefit if the Bill is passed? Secondly, why is an arrangement which four previous Labour Administrations found acceptable suddenly to be removed? I attended nearly all the Standing Committee debates and I still do not know who will benefit from the Bill.
The National Health Service patient certainly will not benefit. He will have to compete for National Health Service resources with people who would previously have opted for private treatment. He will also have to compete with others for the services of specialists, many of whom will opt out of the National Health Service, and even leave the United Kingdom. The medical profession will net benefit from the Bill. It will become more difficult for it to treat patients in one hospital. The National Health Service will lose revenue from pay beds.
All we are left with are the members of COHSE, NUPE, NALGO and the ASTMS. They probably do not realise that the resources to be used to implement the Bill could be used to improve conditions in hospitals or to fill some of the vacancies that cannot now be advertised. They could be used to employ nurses who cannot find jobs. The foreign exchange earned by consultants could be used to build up the National Health Service. The members of the unions do not realise that the resources for the implementation of the Bill could be used for purposes having a higher priority in their eyes. Do the union


members realise the implications if the lifeline to a vigorous private sector is whipped away from a sinking, bankrupt health service? The Bill is not about elimination but separation.
The Government have spent much time recently asking people to make sacrifices. It is now time for the Government to make a sacrifice. If they accepted New Clause 4 the Bill would remain on the statute book, the implementation of Part II would be delayed and Parts I and III could proceed. Many constituents will have to defer things that they cannot now afford for at least two years, and the Government should do the same.

Mr. Hoyle: I am disappointed with the lack of radicalism on the part of the Liberals. I thought that they would vigorously attack privilege. I hoped that they would be with us in supporting New Clause 2.

Mr. Cyril Smith: The hon. Member should take note that while the Liberals may or may not attack privilege they do defend freedom.

Mr. Hoyle: The hon. Member for Rochdale (Mr. Smith) is saying that he defeinds the freedom of those with a thick cheque book to jump the queue ahead of the needy. That is not like him, and it is unusual for him to put forward such an argument. In other circumstances he would have been with us. I wonder who has intervened.
Throughout the debate, the stench of hypocrisy has drifted across the Chamber. The hon. Member for Ealing, Acton (Sir G. Young) attacked cuts in National Health Service spending in his constituency. Does he say that he is opposed to the present cuts, and, if so, that if there are further cuts he will support us in the Lobby against them? Does he mean that the Tories are not in favour of any cuts at all?
What are the Tories talking about? They are always sneaking of expenditure cuts, and it is only when they get down to a particular subject that they decide that cuts should take place elsewhere. I am more and more confused about their policy, because if they return to power it is obvious that they will slash spending on the National Health Service.

I wish that they had the decency to come clean and say where they stand on this matter.
The right hon. Member for Wanstead and Woodford (Mr. Jenkin) referred to a survey commissioned by private medicine. I challenge him about the views of the trade unions. He did not say what was the size of that survey. The trade unions are totally opposed to private pay beds, but the right hon. Member prefers to rely on the evidence of a small and insignificant survey commissioned by an interested party.

Mr. Patrick Jenkin: The hon. Member is trying to slide away from the issue. He has not answered the question which I put to him when he interrupted my speech. Is he prepared to say outside the House that one of the leading polling organisations has distorted the results to please its clients? Is he prepared to accept that NOP conducted the poll honestly and competently according to the highest standards of polling?

Mr. Hoyle: The poll was commissioned by private medicine. The right hon. Member must tell the House the size of the sample.

Mr. Patrick Jenkin: The sample was just under 2,000 people, the normal size for probability sample surveys of this kind.

Mr. Hoyle: There are 450,000 members of my union but the right hon. Member is claiming to represent their views on the basis of a sample of 2,000. That is nonsense, and it puts the matter in perspective.
The issue is one of privilege in our society, and the Conservative Party is defending one of the last bastions of privilege. My hon. Friend the Member for Bristol, North-West (Mr. Thomas) suggested that other private agencies might be set up. If the Tories are so concerned about freedom of choice, I cannot understand why they do not put forward the case for train drivers employed by British Rail being allowed to run private trains based on a split contract under which they would work part of the week for British Rail and for the rest of the week run a private train. Naturally, they would only run main-line services and allow branch services to die.
It has been an empty debate, but my right hon. Friend the Member for Blackburn (Mrs. Castle) is always worth listening to. I fully understand her dilemma. She rightly accepts the compromise—and it was a compromise—which was forced upon her. Of course, we are not bound by machinations. The hon. Member for Canterbury (Mr. Crouch) objected that what went on upstairs might be defeated on the Floor of the House. I object to what goes on behind closed doors. That is what has happened in the case of these proposals for the phasing out of pay beds. They came from Lord Goodman. That is the truth of it. I am filled with great suspicion. Within six months, 1,000 pay beds will be phased out, but it is no secret that they are already very much under-used, and, indeed, that many of them are not used at all.
We are, therefore, not really getting to the core of the matter. It is the remaining pay beds that we are arguing about here. The hon. Member for Canterbury talked about hustling. Four years is proposed by one amendment. The hon. Member could have mentioned two other amendments proposing 1978 instead of 1980. It is right that we should have a period of time, but what we are saying is that we want a date when private practice within the NHS will come to an end.
I am one of those in favour of the total abolition of private practice. I have not agreed with a great deal of what has been said by hon. Members opposite, but I agree with the hon. Member for Somerset, North (Mr. Dean) in his warning that we should beware that in getting private practice out of the NHS we do not create new standards outside it. I recognise that danger in that at present we have some control over private practice while it is within the NHS but that immediately it goes outside the service different standards may be set for it, as is the case in education with the public schools. It is a fair comment and many of us share that fear.
We are concerned that we do not set up another monster, another set of privileges accruing to the wealthy in our society. That is why I would like to see not only the abolition of private practice within the NHS but its abolition altogether. I am not afraid to say that, nor

have my hon. Friends been afraid to say it.
I understand the position of my right hon. Friend the Secretary of State. He, like his predecessor, has been bound by the decisions which have been arrived at, but we are not. We believe that different proposals could have come back to us if Lord Goodman had not been called in to intervene. That is why I appeal to my hon. Friends to vote with us tonight if we divide the House so that we insert a date when private practice within the NHS will come to an end.

Mr. George Thompson: As has already been pointed out by the hon. Member for Edinburgh, West (Lord James Douglas-Hamilton), this is very largely an English debate. I am glad to see that the hon. Member for Aberdeen, North (Mr. Hughes) has come in. I can see that he is going to help us come to a decision by giving us his advice on the matter.

Mr. Robert Hughes: I hope that the hon. Gentleman will take it.

Mr. Thompson: That remains to be seen. I must await the arrival of the hon. Gentleman's advice before I can say whether I can take it. I never swallow medicine without looking at it first, especially when I have some doubts about the doctor.
This is an English debate, but it is remarkable that no Scottish Minister is present, although on Second Reading when I got up to speak I attracted the Under-Secretary of State for Scotland for a brief period, so who knows what fleeting apparition may grace this debate yet?
In Scotland we already have a health service which is overwhelmingly committed to the service of the whole community, the sort of health service to which the hon. Member for Huddersfield, West (Mr. Lomas) referred earlier and which he posited as being desirable in England. We have it in Scotland already. If people wish to pay twice for medical care, they may do so, but they must do it outside the NHS.
Pay beds are not a burning issue in Scotland, because there are so few of them. The Dumfries and Galloway Health Board is not mentioned in


Schedule 2 so little are we afflicted in my constituency by the problem of pay beds in the NHS. Their number has been steadily declining in Scotland, and I believe that even without the Bill they would have disappeared in due time. Nevertheless, as I said on Second Reading, we in the Scottish National Party are not averse to helping the progress on its way. The hon. Member for Edinburgh, West asked whether we could afford to phase out the Scottish pay beds. I believe that we can, because there are certain things that we could cut out.
7.15 p.m.
The other morning I was having my breakfast, doing no harm to anyone, and listening to the radio, when I heard the Minister of State, Department of Industry, tell us that he was seriously thinking of geting on with a super-Concorde—a super-Concorde at this time. Let us hope not.
If the Government wish to cut something in Scotland I can tell them some things they could cut quite readily, to the benefit of the health and safety not simply of this generation but of generations ahead—indeed, I understand for something like the next 50,000 years, because of the length of the half life of nuclear waste. They can discard their plans to have a plant producing tritium, attached to the plutonium factory at Chapelcross, which is disguised as a nuclear power station. We have no need for it.
No Scottish Government would have squandered money on the Concorde. No Scottish Government would have the money to squander on a super-Concorde. I believe that the good sense of the Scottish people would prevent any Scottish Government, even if that Government had the money, from squandering it on such a useless project. Nor would a Scottish Government ever want to produce tritium.
Let those who want to be in the super-Power class delude themselves if they want to, but we believe that it is high time that the United Kingdom came off its high horse and recognised where it really is in the Power league—and in any case we hope to get off this horse in due course.
Like the right hon. Member for Blackburn (Mrs. Castle), I am emotionally attracted to New Clause 2, but, as I have said, the problem is not a serious one in Scotland, where we can expect pay beds to disappear anyway. So I am prepared on this occasion to accept the view of the Secretary of State.
I fully accept that he has to consider the position in England, and especially South-East England, since it was pointed out on Second Reading that the position in the North of England is somewhat different from the position in the South-East. If the right hon. Gentleman finds himself so convinced by the arguments for New Clause 2 I am perfectly prepared to advise my hon. Friends to follow him along that line. Equally, if he rejects New Clause 2, I shall follow him in that. I take the point that a clean, sharp break would, as the hon. Member for Brent, South (Mr. Pavitt) said, save time, energy and money. After all, I take the same view about the contrast between devolution and independence for Scotland. However, as I have said, it seems to me that I ought to have regard to the situation in South-East England, because it is one which concerns people at their most vulnerable.
In considering New Clause 4 I have sometimes had the thought that perhaps the Tories are hoping for a General Election before the implementation date set out in that clause, in which case the Bill might not be implemented at all. If that is the Machiavellian thinking behind their proposal, I do not go along with them. Furthermore, I assure them that they need not count on the return of Galloway to their fold at the next General Election in order to allow their Machiavellian policy to prevail.
I am always being attacked in Galloway by Tories who tell me that I have maintained a deafening silence about freedom—freedom, they tell me, in education and freedom in medicine. The question is, freedom for whom? In Galloway 99 per cent. of the people have never had freedom in education. Indeed, I am quite sure that 99 per cent. of us never wanted it, because we were perfectly satisfied with the system that was there for our use. I suppose that the fact that at least two of us have arrived in this Chamber is some sign


that our education system was indeed very good. In medicine, as I have said, we have not had the choice. I was recently talking to doctors in Stranraer, and they put it to me that they wanted to see pay beds continue. I asked them whether they had any pay beds, and they replied that they had none. Did they have any private practice on the side? Again, no.
It seems to me, therefore, that in Galloway we are happy with the situation we have, and all the talk about freedom is simply talk about freedom for one narrow class of people. However much money they may wield, that is not the sort of freedom we are looking for in Scotland.
The freedom we are eagerly awaiting in Scotland is freedom to run our own health service in our own way so as to promote the health of the whole people of Scotland, freedom to direct our own resources—since we do not intend to scrounge off anybody—towards housing, the social services, health, education, and more especially, towards those areas which suffer from the scourge of multiple deprivation. Devolution will give us the opportunity to start on that task. Independence will give us the opportunity to carry it through to a successful conclusion, so that the people of Scotland will be able to look the rest of the world in the eye with pride—pride in our health service, in our education service, and in all aspects of our life.

Mr. Robert Hughes: I understand that at an earlier stage the hon. Member for Edinburgh, West (Lord James Douglas-Hamilton) made some chastising remarks about the absence of Scottish Labour Members from the Chamber. He is entitled to make that remark since none of us was here, but we cannot always plan our affairs and the way in which we spend our day in Parliament. A number of us, including myself, have today had a long and fruitful meeting with shop stewards from the yards in Scotland involved in the building of oil rigs, modules and so on connected with work in the North Sea. The shop stewards were especially concerned about future employment prospects and the immediate problem of redundancies.
Therefore, I believe that my absence from the Chamber this afternoon can be

justified on the basis that that is an important problem and my plans could not have been made in advance. When the arrangements were made for the shop stewards to come here to see us, we could not at that time foresee what the debate would be. Nevertheless, I hope that my presence in the Chamber this evening will assure the hon. Member for Edinburgh, West that I am very concerned about the National Health Service in Scotland and about the pay beds situation there, which I want to see ended as soon as possible.

Lord James Douglas-Hamilton: When the hon. Gentleman was a Minister with responsibility for health, he was extremely conscientious in attending Committees and debates in the House in which health matters were discussed. Is it not only fair that a Scottish Office Minister should be present when important matters relating specifically to Scotland are discussed?

Mr. Hughes: In view of the fulsome compliment with which the hon. Gentleman began his intervention, I must agree with the first part of what he said. As for the second part, however, I must remind him that Ministers may equally well have valid reasons which prevent their being in the Chamber. I assure him that my hon. Friend the Under-Secretary of State would have been here if he had not had a pressing engagement which kept him elsewhere.
I turn now to the speech of the hon. Member for Galloway (Mr. Thompson). Although I agree with much of what he said, especially on the question of freedom for whom, I think that he takes a rather simplistic attitude to this whole subject and I quarrel with him when he begins his remarks by saying that this is an English debate. It is not an English debate. It may well be the case—the figures in the schedule show it—that the vast bulk of pay beds is to be found outside Scotland, but we have 234 pay beds within Scotland. Moreover, even if we had no pay beds in the whole of Scotland, it would still, in my view, be an issue on which Scottish Members with an interest in the National Health Service as a whole ought to take part and take an interest in what happens south of the border. I reject entirely the suggestion that between north and south of


the border there is suddenly some difference in people and suddenly a great difference of principle in the way our affairs should be run.
I welcome the hon. Gentleman's remark that, although the majority of pay beds were in the South-East of England, he thought it right to take part in the debate. Indeed, I wish that the Scottish National Party would take a more global interest than it does at present in the affairs of the United Kingdom. It is too simplistic to say that, come the day of independence, all will be well, manna will fall from heaven and suddenly everything which is ideal will come to pass in Scottish life.
Looking back into Scottish history, the Scottish National Party will find that the greatest obscenities practised against the Scottish people were practised by Scots themselves on their own people. In fact, it is still true today. I find it astonishing that one of the SNP's great supporters, one of the so-called great patriots of Scotland today, is a man now under investigation because of insider dealings in his shares. I refer, of course, to Sir Hugh Fraser, who is such a Scottish patriot that he pays his workers in London more that he pays his workers in Glasgow. However, I do not wish to be diverted along that road, since it is no more than ancillary to the National Health Service, although the point is worth making since we are dealing here with the question of resources.
How should we use resources in the National Health Service, and how should the service operate in relation to individuals? We are sometimes inclined to regard the pay beds issue, as we regard some other issues, as though it were some sort of esoteric matter which had no impact on people's lives.
I should make plain that I have always been against the system whereby consultants in the NHS were able to operate private practice on the side. I make no bones about that. I believe in an integrated health service. But if I had any doubt about the way in which consultants behaved towards patients, those doubts would have been dispelled by an incident which, although it took place a number of years ago, I believe could still occur.
The granddaughter of a lady—she was at one time my landlady—had a heart complaint. It was picked up in the normal routine checking by the school health service, and it was discovered that she needed remedial surgery. Anybody who knows about heart complaints in children knows that surgeons like to do the operation before the child passes from primary to secondary school. Quite apart from the stress of changing schools, there is also the fact that physical activity in secondary school is much greater than it is in primary school. Therefore, as I say, surgeons wish to have the operation done before the time of transfer.
In Scotland, because of our individuality, because we have a different education system, that transfer takes place at the age of 12, not 11. Although we sometimes fall into the trap of glibly speaking of the 11-plus, the transfer in fact takes place at the age of 12.
After the child had passed eight years of age, time went by and the parents and grandparents were extremely concerned that the operation should be carried out. At that time, it could not be done in Aberdeen—I suspect that it still could not be done in Aberdeen—so it had to be done elsewhere, and the parents and grandparents consulted the surgeon about what was to be done. "You have told us", they said, "that you want it done before the girl goes to secondary school". His response was "It is very difficult. I have a long waiting list, and it will take time." They were not wealthy people, and they asked the consultant whether there was any way in which they could have the operation done before the child transferred. He said "If you care to come on to my private list, it can be done in six months' time". I believe that the activities of that kind of consultant besmirch the name of the medical profession.
I do not blame the parents and grandparents for taking out a second mortgage to pay for the operation. I do not blame people who have recourse to private medicine in such circumstances. I suspect that if it happened to one of my children I would set my principles aside and do the same. When I am speaking about not just the health but possibly even the life of a child of 10, I cannot say that I would be a man of principle.


There are times when people may decide that they must have recourse to private medicine.
7.30 p.m.
That incident has burned in my memory all these years. I believe that the medical profession owes a great deal to society because of its failure to recognise exactly what pay beds do. When we speak about jumping the queue, we are not speaking about cosmetic operations, perhaps carried out simply because someone wants to remove a facial disfigurement. In probably nine cases out of ten we are speaking about an individual's future health and happiness. I do not know how any Conservative Member can defend the mercenary outlook which I have described.
I have always had a strong belief in the views of Nye Bevan, but I believe that he made a mistake at the time of setting up the NHS when he agreed to consultants being private contractors to the service and to the whole business of private consultants and GPs. If he were alive, he would probably tell me that it was all right to say that with the benefit of hindsight but that the Labour Government of the time had to face the consistent and virulent hostility of the medical profession and the Tory Party, who were opposed to the setting up of the NHS. He might say that in the circumstances the Government of the day had no choice.
From time to time I see cars with a little sticker in the back window saying "Patients before politics". That is nothing but sheer hypocrisy, because the medical profession has always played politics with the lives of its patients when it comes to the question of resource management in the NHS.

Mr. Patrick Jenkin: Shocking.

Mr. Hughes: The right hon. Gentleman knows perfectly well that it is a fact.
When the Government, I believe with the support of the whole country, were anxious to see the family planning service extended into the NHS, I think that we were faced with an ultimatum from a small number of consultants. I have had many representations from consultants in the city of Aberdeen opposed to the principle of an item by service payment for family planning. I apologise if my figures are wrong—I have had no oppor-

tunity to check them—but I understand that it will cost the Grampians Health Board about £40,000 a year to pay consultants to provide a family planning service within the NHS.
The medical profession contains some of the best trade unionists, some of the people most able to use the weapon of power to put pressure on Governments and others to get their way. They may be in a minority, but they have a powerful minority voice.
The time has come when there should be an end to the argument about pay beds. The Bill does not go far enough. I would prefer the separation of the NHS from private practice. When people speak about freedom, it almost always comes down to cheque-book freedom. That is true in education, housing and the health service.

Mr. Hector Monro: When the hon. Gentleman is ranting on, will he not accept that the last pay beds authorised in Scotland were authorised by the Labour Government in 1968?

Mr. Hughes: Even if that were so, it still would not make it right.
I believe in the kind of freedom within which people are treated as individuals, irrespective of class. I am not one of those who think that we are all equal in the sense that we all have the same physical or mental capabilities and the same ability to take the opportunities that are available. I believe, however, that we are all equal to the extent that, whatever our class or status, we are entitled to treatment within the National Health Service as of right. The idea that it should be possible to buy privilege is obnoxious to me. I know that it is obnoxious to the Government. They may well have had to compromise, but I hope that my hon. Friends who share my views will go into the Lobby to put an end to the present system, which is long overdue for complete eradication.

Mr. Robert Boscawen: The hon. Member for Aberdeen, North (Mr. Hughes) spoilt what would have been quite a good speech by his suggestion that the consultants' profession spent its time engaged in hypocrisy and political action within the health service.
The hon. Gentleman is correct in his ideals, that no matter whether the individual is a private patient or an NHS


patient, and no matter whether the consultant is a full-time or part-time NHS consultant, the quality of service given to the patient should be the same, whatever his race, colour or creed. I believe that that is an ideal we all share. I certainly do.
I do not think that the Labour Party fully understands the implications of the Bill. It is creating a double standard by separating private health care from the State, the very thing that Labour Members profess not to want to do. I hope that they will think very hard about the fact that it is what they are doing.
One of the reasons why consultants hang on so strongly to the private patient concept dates back to the very beginning of the NHS. It has often been said that the general practitioner was given the patients and the consultants were given the beds. The consultants lost a one-to-one relationship with their patients when the NHS started. They do not have much of a one-to-one relationship with their NHS patients. I wish they did. They see the NHS patient for 15 minutes or half an hour before they have to carry out an operation on him, and then see him again in the few days while the patient is recovering. That is the end. The consultant can follow a private patient through. That is much more interesting and rewarding work for the doctor concerned. It is one of the reasons why the consultants have been so strongly opposed to the removal of all private patients from the NHS.

Mr. Robert Hughes: I am very grateful to the hon. Gentleman for giving way. I do not understand why it is impossible within the National Health Service for a consultant to see his patient through from beginning to end, as the hon. Gentleman suggested. It is a matter of organisation. I have been a member of a health board, and never in my experience of the National Health Service has any agency outside the medical profession at any time sought to dictate to it how it should deal with the patients within the service Nor would I ever agree that there should be any outside dictation.

Mr. Boscawen: Of course, the hon. Gentleman is right. It is a matter of organisation and of resources. At the

present time we have not that organisation or those resources. Indeed, I am quite appalled at the state of waiting lists in the National Health Service throughout the country. It is by far the worst feature of the whole of health care in this country. I was asked to look into it some weeks ago. I did so, and the more I have looked into it the worse I have found it to be. It is not necessary to go very far for the evidence. All the evidence we need can be found in Adjournment debates in the House of Commons, night after night, in which Members of Parliament tell the same story. It is an appalling situation. We all know these cases. We all have them.
The hon. Gentleman told us of the sad case of a small girl who needed treatment, and I fully sympathise about that. I know a young woman who is in considerable pain and who cannot get treatment within the National Health Service for another six months. During this period she will be under the care of an anaesthetist. Her family relationships are harmed, her work is impaired, and she and the family are going through the most miserable period they have ever known in their lives.
That, I am afraid, is the NHS of 1976. We ought to be talking of what can be done about this—[HON. MEMBERS: "What about the cuts?"] Yes, I will talk about the cuts. If serious cuts in the National Health Service have to be made there will be a great deal more suffering in this country than we have known for a long time. Anyone who wants to create that suffering should not be a Member of this House. It will be a tragic day if one Government or another are forced to cut further into the resources of the National Health Service, but from the look of the figures I am afraid this may happen. We do not wish to see cuts made in the National Health Service.
I want to see a reorganisation of the resources of the National Health Service, because I know that they are not being deployed correctly. There is still tremendous waste. Far too many people are pushing pens and paper around in the health service. I cannot absolve Conservative Governments from this. We brought in the change in the organisation of the National Health Service and it did


not work as well as we had hoped. We should concentrate our efforts on reorganising the resources of the National Health Service, and not on this Bill, which will not shorten a single waiting list in this country—rather the reverse.
People do not go for private treatment because they want to queue jump. That is not their basic reason for seeking private care. There are other reasons, too. It is not just queue jumping for the sake of getting there first. It is because many of them have very strong social reasons. If we are to have a common waiting list, we have to allow for the social reasons for putting people in the queue, as well as their medical priority. It cannot be done otherwise. If all the private patients are to be put into the NHS queues, in the same mix, quite rightly, as other people—I have no objection to that—many of them will still have strong social reasons for going above others who may be awaiting non-urgent operations. In some cases there may be an improvement, but in the main—and I have looked at this fairly carefully—I do not think the Bill will make the slightest difference to the length of the waiting lists. That is why it is quite irrelevant and wrong to bring in the Bill at this time.
The right hon. Member for Blackburn (Mrs. Castle) said that we stand by Goodman, and that if we were to delay the Bill another six months that would be breaking the Goodman agreement. The Goodman agreement was hammered out after months of turbulence, anger and hard feeling within the National Health Service. I am glad that the right hon. Lady has just come into the Chamber, because I am talking about the Goodman agreement which she managed to achieve after months of argument, lack of confidence and turbulence among all sides of the National Health Service.
7.45 p.m.
A year has passed since then. I think that the right hon. Lady will agree that the situation has calmed down somewhat, and that the doctors are not acting in the way that they did a year ago, nor are some of the staff or nurses in the hospitals. A different situation has arisen. That is why I think there is a very good case for rethinking on the Bill and delaying it another six months, before we

lose more of the resources which are so badly needed by the NHS.
We should think again before dividing health care into a private service and a public service, with two standards of care in the country. That is what will happen if the Bill goes ahead and results in separating private medicine from the NHS. I believe that the Government would do well not to push the Bill so far and so fast. They are not achieving their ends. Their ends, I believe, are the same as ours—to improve the health care of all patients in this country, irrespective of who they are. The Government are not achieving that end with the Bill.
Let the Government get down to the task of trying to reorganise the National Health Service as soon as possible within the existing resources in order to make better use of them. Having done this, the Government could ask us to look again at the question of private practice and whether it is harming the service as much as they believe.

Mr. Martin Flannery: After listening to the hon. Member for Wells (Mr. Boscawen), my viewpoint held hitherto, and which I am now reiterating, is stronger than ever on this issue. In my opinion, there is no group in the world more skilled and able at holding up human progress than the British Conservative Party. It uses every trick in the book. It makes every ploy that it is capable of making. Those things are said blandly as though they were profound truths.
I listened with great interest to the boring statement of the Shadow Minister, the right hon. Member for Wanstead and Woodford (Mr. Jenkin), and to his sheer blandness in endeavouring to preserve elitism and privilege. This was visible from almost every sentence. In the light of our history, it is almost inconceivable that such arguments can be deployed in 1976 by the Conservative Party. No doubt many Conservative Members, if they get the chance, will be doing the same in 2076. Certainly their arguments are amazing to those of us on the Labour Benches.
We have had mention of firms which literally raid the National Health Service like the Seventh Cavalry. We hear of


BUPA struggling for privilege. We hear speeches in defence of, for instance, some grouping called "freedom-loving doctors". My right hon. Friend the Member for Blackburn (Mrs. Castle) quoted the representative of the consultants some time ago and was prompty accused of almost waging war against the consultants. We heard a quotation from one of my hon. Friends from a speech by Aneurin Bevan about having to stuff the mouths of the consultants with gold.
Well, Mr. Deputy Speaker, you pays your penny and you takes your choice. We can make up our minds about the vivid statements made by Opposition Members in defence of their beliefs, but I hope that the message goes out loud and clear to the people that the Conservative Party has not changed one iota. It will still defend privilege and elitism and want everything for itself as long as it can manage it.
I speak as a ex-teacher, as hon. Members know, and for long years I have gazed at private schools and all that they mean with their small classes and favoured treatment for their children, as opposed to the children of our people generally.
Perhaps I might briefly return to these "freedom-loving doctors". I have always been of the opinion that the vast majority of people in the National Health Service struggle manfully to do their duty by their patients. I hold to that belief. I believe that more and more of them are doing that. But there is still a small section who see the service as a means to wealth. In other words, they wish to capitalise on the sickness of their fellow human beings. It is that small group which really is our trouble in the service.
The vast majority of our doctors, nurses and others who work in the service are doing their utmost under very trying conditions. Many of us well remember what happened before the war when people could not send their children to a doctor if they had not the money and when even bad debts were peddled from one doctor to another. That was the kind of situation against which we were struggling when we fought for the National Health Service, which the Conservative Party opposed tooth and nail and finally had to accept but against which it is still fighting a delaying action.
When I hear statements to the effect that the Government's proposal will make practically no difference, I ask whether a principle is any the less a principle simply because it deals with a minority. It seems to me that the principle is all the more a principle when it is helping a minority. In this case, however, it is helping the vast majority. It is helping all those people who need help.
When we talk about cuts, we should examine exactly what it is that we are discussing. Day in and day out, Government supporters have asked Opposition Members, who want massive cuts in public expenditure of an order which makes the imagination boggle in the present context, to specify to us where those cuts should fall. There is never a day that goes by that from the Government Benches, assuming that the opportunity does not arise in formal debate, someone does not shout "Where would you make the cuts?" We know that the cuts would not be made in defence and, therefore, that we are discussing matters other than defence. We know as sure as I am standing here that those cuts would fall upon the National Health Service on a grand scale. We know that, and the Conservative Party knows it.
Once again I say to the Conservatives "Tell us what cuts you would make in the National Health Service or he quiet about it and let the British people know exactly what the difficulties would be when people wanted to go to hospital, when they were in pain and when there was urgency about life." I ask the Opposition to let us know exactly what cuts would be made by those who constantly say that they would not make such cuts.

Mr. Thorne: Does not my hon. Friend agree that the two questions—extending private medicine and cuts in public expenditure—are linked in the minds of the Opposition and that they would cut public expenditure in the National Health Service and force people to pay through private medicine to get treatment when in need?

Mr. Flannery: That is absolutely true, and the Opposition know it.
We on the Government Benches know that we are struggling for the right of people to use the National Health Service


when in need. We know that the Conservative Party would substitute for this what we call queue-jumping where, if the patient's purse is a long one, he can all the quicker get to hospital, where all the expensive equipment provided for the National Health Service from public funds is used by the consultants to line their own pockets in the cases that I am discussing.
That is what Government supporters are against, and we place it on public record repeatedly. If it is suggested that because we tell this truth we are to be blackmailed by a minority of consultants, so be it. It is very sad, but they should be seen to be doing precisely that—blackmailing and wanting their mouths filled with gold. If these are the "freedom-loving doctors" let them go to freedom-loving areas like South Africa and Rhodesia where these things go ahead without let or stay. However, we believe that that would not happen. We believe that the worst that would happen is that those doctors would go into private practice and that they would not go away. They could do that if they wished, but we do not believe that they would.
In supporting New Clause 2, there is for us in this struggle a deep abiding principle which we will not forgo. It is the right of all to a service without having to pay through the nose for it if they have the money to do so. It is the right to a free service for all our people. We believe that that is what our people want us to stand up and fight for in this House.

Mr. Grieve: I rise to intervene in this debate because I have felt horrified throughout its course by attack after attack which has been made upon the medical profession by Government supporters—by the hon. Member for Sheffield, Hillsborough (Mr. Flannery), by the right hon. Member for Blackburn (Mrs. Castle) who assumed the mantle of the enemy of the medical profession and waged war upon it when she was Secretary of State, by the hon. Member for Barking (Miss Richardson) and by the hon. Member for Aberdeen, North (Mr. Hughes) who made a most cruel attack upon a dedicated profession.
No one in this House is more qualified than I to speak of the dedication of the medical profession. Having spent 15

weeks this year as a National Health Service patient I owe to the dedication, the devotion and the care of the doctors and nurses in the hospitals where I was not only my health but my life. They were doing their duty night and day to everyone under their care despite appalling material difficulties, many of them caused by an overweighted administration—

Mr. Kilroy-Silk: Brought about by the Conservative Government.

Mr. Grieve: I accept that intervention. I believe that the administration of the medical profession and of the National Health Service is top-heavy. It is over-administered. That over-administration should be cut in favour of the medical care and the subvention which should go to the medical care in our hospitals.

Mr. Flannery: Did the hon. and learned Gentleman pay, I wonder.

8.0 p.m.

Mr. Grieve: I said a moment ago that I was a National Health Service patient for 15 weeks, so of course, as a NHS patient, I did not pay. However, I got the care and attention everyone gets from doctors in the NHS and I pay tribute to the medical profession.
I am horrified to hear the kind of attack which has been made on the medical profession tonight by hon. Members opposite. There will never be any peace in the service while that kind of attitude prevails. In my 15 weeks in a public ward I did not hear one voice raised by a doctor, a nurse or a fellow patient in support of this scheme to phase out pay beds.
When the right hon. Lady the Member for Blackburn was dismissed from her post as Secretary of State for Social Services and it was announced in my ward there were cheers from the patients and the nurses. [Interruption.] Yes, it is true, and it is right that I should say it because the right hon. Lady has brought this on herself by her attitude to the medical profession. When she says, as she did today, that it was greed and desire for money which actuated the consultants in their opposition to the abolition of pay beds, she overlooks the fact that some of the consultants who are most opposed to it are those who are opposed for reasons of clinical freedom only because they do not get a penny of the


fees of private patients. They are the ones who are serving in teaching hospitals where they give their services so nobly. It is a monstrous slander on a great profession by someone who has held the highest office, in respect of that profession, under the Crown, and she should be ashamed of herself.
There are three reasons why I believe this Bill should be delayed. It will separate private and public medicine altogether. At the moment the two are under the same roof, and when NHS patients desperately need attention it is available, straight away whatever the time of day. It may be in the middle of the night, or, as in my case, at 6 a.m. when my pacemaker failed. What will happen when consultants are serving a clinic at one end of London, and Hammersmith Hospital, Guy's or Westminster at the other end? They will be rushing between the two. The convenience of the present system is one of its greatest advantages.
Secondly, this scheme for phasing out pay beds means that we—or members Opposite—are cutting off their and our noses to spite their and our faces. The health service will be deprived of much needed funds which are at present going into it by the use of private beds not only by the oil sheiks but also by thousands of modestly-off people who are ready to pay for privacy by schemes as such as BUPA or the Private Patients' Plan.
Thirdly, it is disgraceful that for purely ideological reasons we should be subjected in this country to something which will do infinite damage to the health service, and that in support of this we should hear the kind of diatribe against the medical profession that we have heard tonight. I pay tribute to this great profession, which gives itself unsparingly to the care of the needy and sick, and I have been disheartened and appalled by what I have heard from many hon. Members on the Government Benches tonight.

Mr. Kilroy-Silk: I join the hon. and learned Member for Solihull (Mr. Grieve) in paying tribute to the medical profession. The vast majority of those in it, whether they are consultants, doctors or ancillary workers, are dedicated to the

profession and to the patients they serve. I do not think that my hon. Friends have made the kind of attack that the hon. and learned Gentleman talks about. Whether they have or not, I agree with him about the dedication of the vast majority of the profession. Nevertheless, the hon. and learned Member will have to accept that there is still in that profession a militant minority which has, in fact, waged war on the previous Secretary of State.
There was, and still is, a militant minority which puts its own privileges and vested interests before those of the patients and which is prepared to play politics, and does so, with the patients. This minority is holding the sick to ransom. What kind of medical profession is it that resorts to industrial action, using patients as pawns in that action, as was the case recently in the junior hospital doctors' dispute and in the protest over pay beds? That is not exactly the kind of behaviour one expects from doctors if one gives a cursory glance at their Hippocratic oath. It does not add to the prestige or general demeanour of their profession; in fact, it demeans the whole profession. While accepting that the vast majority are dedicated people who work hard, we must also realise that there are others who are more concerned with lining their own pockets than they are with the health and welfare of their patients.
The hon. and learned Member for Solihull said that there would be difficulties if private and public medicine were separated because doctors would have to spend time travelling from an NHS hospital to a private clinic. He claimed that this would be a waste of time and resources. It would not, because there is no need for them to travel to their private clinics. Let there be a full-time salaried National Health Service.
The hon. and learned Member also claimed that by eliminating pay beds we were depriving the NHS of resources. Far from it. By separating the NHS from private medicine we are devoting far more resources to the service where they properly belong. The hon. Member for Wells (Mr. Boscawen) said in an impassioned speech that there were desperately long waiting lists at NHS hospitals, yet his hon. and learned Friend who is sitting almost next to him wants


to continue this elitist, separate and selfish, queue-jumping sector alongside the NHS. How can he possibly square the two?
It has been said on many occasions that this is an ideological battle. Whose ideology is it? The ideology is coming not only from this side of the House. It is coming also from the Opposition. They keep talking this nonsense about freedom. The Conservative Front Bench makes this its catch phrase. But whose freedom are we talking about? Are we talking about the freedom of a few consultants to have freedom of clinical practice, or are we talking about the freedom of the vast majority of people in this country to get proper and adequate medical care at the time when they need it? That is the freedom that we on this side are talking about, not the freedom of the privileged elitist few.
When one looks around the country one sees that the Conservatives have less than a handful of seats in Scotland, and they have been virtually decimated in Wales. They have no grip at all in any major industrial city in England. They draw their support from the suburbs and their hinterland—the suburban, privileged, cossetted hinterland of England. They will do anything to protect and advance the interests of this minority. That might be forgivable if the minority were underprivileged and deprived. But this minority, which the Tories support and whose cause they advocate, can afford the wherewithal for private medicine and for the consultants who practise it, who have a large enough purse to purchase private education and those who will provide it, and who will get tax relief on their mortgages and the rest.
Those were the kinds of things we heard repeatedly in Committee on the Finance Bill. The Conservatives were always speaking for a minority group which was already cossetted and privileged and which had a vested interest to protect. It is no wonder that the Conservative Party is no longer representative of the geographical entity of the United Kingdom and will be seen to be less so.
There are many defects in the Bill. I described many of them on Second Reading, and that may be why I was not

selected as a member of the Standing Committee. One of the major defects is its failure to put a time limit on the separation of pay beds from the National Health Service hospitals. I wholeheartedly support my hon. Friends in their proposal to include New Clause 2 in the Bill.
Pay beds are an affront to the whole concept of the National Health Service. They are a blight on what was considered to be a national service which would be guided by the principle that health care would be available to all. determined only by need and not by the ability to pay. That principle is in no way served by the existence of this separate pay bed sector within the National Health Service.
In spite of what the Conservatives may say, pay beds are there so that those who can pay can jump the queue. There is no other conceivable reason why they should exist. It is no good the hon. Member for Wells saying that they give people the freedoms to choose. None of my constituents has the choice or the freedom to purchase private medicine or private education. They do not have the wherewithal, but their need is just as great and just as serious as that of the privileged sectors—such as the business men—for whom the hon. Member speaks.
It is nonsense to talk about its being necessary to have pay beds for certain people who have social reasons or to suggest that the beds are there to enhance freedom. They enhance only the freedom of the consultants and those who can afford to pay. The pay beds are parasitic on the National Health Service. They could not exist without the resources available within the NHS hospitals. We know from a report produced by the House that many consultants go further in that they not only use the NHS facilities without proper charge to themselves but they take those facilities outside to use in their own private rooms and clinics. That is a great abuse of the facilities provided at the taxpayer's expense, but the taxpayer has to wait for them at the end of a long waiting list.
We have heard many indications of how quickly a patient can get an operation, a hospital bed or a consultancy if he is prepared to pay. My nine-year old


son needs an operation. It is not serious or urgent, but he needs it. He will have to wait 18 months on the NHS list. I was told by the consultant that if I was prepared to pay my son could have the operation next week. is that not a glaring demonstration of the whole raison d'être of pay beds, that they are there to enable those who can afford to pay to jump the queue and to get privileges and treatment at the expense of those who cannot afford but whose illnesses may be just as serious, or even more so?
Pay beds will not be separated from the National Health Service unless my right hon. Friend the Secretary of State tonight takes his courage in both hands and accepts the new clause. He knows that this is neither his nor his predecessor's Bill. It is Lord Goodman's Bill. He knows that the Government have already abdicated their responsibility for governing, as is exhibited in the Bill. We have strayed a great deal away from our principles and the proposals in the manifesto. We were pledged and our principles demand that once and for all we should separate pay beds from the NHS. There is no reason to go further than that and take out some kind of guarantee for the eixstence of private medicine.
I do not know what this so-called Socialist Government are doing in guaranteeing the existence of private medicine. If we are to ensure that the people who need treatment get it, irrespective of their income and when it is clinically necessary for them to receive it, only one conclusion can be drawn. We must once and for all take out this excrescence in the National Health Service, which is there only because of medical politics a long time ago.
I do not believe that 1980 is an unreasonable date. I would want it to be much earlier, but I hope that my right hon. Friend tonight can accept that we on this side and our constituents who do not have the privilege of the Conservatives and who do not have the ability to get what they want when they want it are entitled to and should have a truly national health service.

8.15 p.m.

Mr. Patrick Mayhew: It is profoundly saddening, at a time when the National Health Service, which we in this House all cherish and

support, is in crisis, that our debate should have been stained and disfigured by several speeches which demonstrate the profound and atavistic hatred of certain hon. Members, a hatred which is quite impervious to argument. I think particularly of the speech by the hon. Member for Sheffield, Hillsborough (Mr. Flannery), who seems to hold about this party a view which bears no resemblance to the truth. The hon. Member for Ormskirk (Mr. Kilroy-Silk) made a speech so impregnated with hatred that I fear that his mind must be totally closed. I wish to assure them both, not because I believe my words will have much effect on their minds, but because I want to get them on the record, that my arguments will be advanced out of a desire to preserve the health service and to improve its standards, and out of a desire to improve the standard of care which any Government in this country can afford to give to our sick.
Neither I nor any member of my family belong to any of the insurance schemes which provide for private treatment. I cannot match the recent record of my hon. and learned Friend the Member for Solihull (Mr. Grieve), I am glad to say, but years ago I spent quite a long time in St. Thomas' Hospital as a NHS patient. I came to the firm conclusion then that I could not hope to get better treatment in a private ward and I resolved never to seek it. I was influenced, too, by the fact that at any time of the day or night there was a large number of extraordinarily pretty girls in the public ward. That is a situation which does not obtain in a private room and that, no doubt, was a factor in my judgment.
If I were a consultant I do not know whether I would wish to practise privately. I am pretty sure that I would, although I would want the majority of my service to be in the NHS. I would want to practise privately in part because I would relish the independence that would give me. I should not wish to serve as a full-time salaried servant of the State because I should find that incompatible with exercising my profession with the independence that I should want. I defend resolutely the right of a consultant or doctor to practise medicine privately. That is the Government's position, and that has been the position of successive Governments since the war.
I have already said that I should not wish—for a practical reason, namely, that I do not think that I could get better treatment outside the National Health Service—to be a private hospital patient. At the same time I defend resolutely the right of those who wish to do so to set aside money in insurance premiums to enable them to be operated upon by the surgeon of their choice and to recover in the environment of their choice. I recognise the advantages which many people believe lie in private treatment. By no means all of them are well off or even middling off.
Successive Governments have declared their support for the principle of private medicine that operates in tandem with medicine practised under the NHS. They recognise the need for the services of doctors to be available in NHS hospitals. They know that they can get a far better bargain for the NHS if they have a small proportion of private beds under the same roof as NHS beds in NHS hospitals. They know that they can get a better bargain because they thereby secure a greater proportion of doctors' and surgeons' time. Their time would otherwise be taken up in travelling to the separate institutions that would have to be established.
I firmly believe that the present arrangement confers benefits on both sides. It confers benefits, of course, on private patients. Those benefits are obvious and they do not need to be enumerated. It also confers benefits on NHS patients. On balance, I believe that they get the better of the bargain. They get a larger proportion of the time of the consultants and doctors than would otherwise be the case. To abolish private beds in NHS hospitals on the time scale envisaged by the Bill must be a bad thing in that it will have substantial disadvantages for the Government, for National Health Service patients and for private patients, to say nothing of the interests of the doctors.
Presumably there must be a substantial countervailing advantage. I have listened to this debate as well as earlier debates and the only advantage I have heard i3 the abolition of what is called queue jumping. What is the evil of queue jumping? It surely lies in the fact that it makes those who are waiting in the

queue wait longer. That is exactly what will happen if doctors have to attend private patients elsewhere in private institutions—namely, nursing homes and hospitals built specially for the purpose —instead of looking after them under the same roof as at present.
If there is no advantage, there are many defects. It is absolutely right for Governments to be concerned about the length of queues. I agree with everything that has been said by my hon. Friend the Member for Wells (Mr. Boscawen) and by Labour Members about the appalling length of the queues in NHS hospitals. Of course, the Secretary of State must be concerned about this matter. He is responsible for the length of the queues in the sense that he has to answer for them. As the hon. Member for Rochdale (Mr. Smith) said, the best thing to do with queue jumping is to seek means of abolishing it. As we all know, that means money. We all know that to phase out private pay beds in the health service hospitals will cost £20 million.
I have a sort of horrified respect for the hon. Member for Brent, South (Mr. Pavitt), who introduced the clause, and his hon. Friends who sit below the Gangway. I have that respect because at least they follow the logic of their policy. They are prepared to acknowledge that they are against all private medicine. I have horror, however, because of the vision that they hold out before us, the vision of a society that will have lost all freedom of choice for anybody. I acknowledge that there are many people who do not have freedom of choice in education or in medicine, but the vision that is held out by the hon. Gentleman and his hon. Friends is that of a society where there shall be no choice for anyone.
Although I have a sort of horrified respect for the hon. Gentleman and his hon. Friends, what about the Secretary of State and his supporters? They must exist somewhere, although we have neither seen nor heard one during the debate.
The right hon. Gentleman is responsible for the health service and we know that it is in a desperate crisis. The right hon. Gentleman cannot afford to lose one penny for the NHS by a self-inflicted wound when its resources are already haemorrhaging away through inflation week after week. He cannot afford to


lengthen one waiting list as they are miles too long already. However, that is what he will do with most of them if he phases out the pay beds.
The right hon. Gentleman cannot afford to allow double standards of treatment to exist in medicine, but that is what will develop if he forces private medicine to be conducted completely separately from the NHS. That is why I believe it is entirely right that New Clause 4 should be supported. That clause suggests putting on the brakes for the moment. At this moment of desperate crisis for the health service it must be madness to lose money, to lengthen the queues and to work towards the development of separate standards. I beg the right hon. Gentleman to heed that, whatever his wilder hon. Friends below the Gangway may have said, and to say at this late hour "Yes, we shall put on the brakes".

Mr. Loyden: I shall not take up the arguments that were presented by the hon. and learned Member for Royal Tunbridge Wells (Mr. Mayhew) except to make one important point. When referring to the National Health Service, the hon. and learned Gentleman referred to the desire of Opposition Members to preserve the service. I think that subconsciously he probably applied the right word. Those who have taken part in the debate have been unified on at least one point—namely, an acceptance that the present queues and waiting lists for hospital attention are matters that we should not accept any longer than is necessary.
I understand that to "preserve" means that something is taken in its existing state and is preserved for a time in the future. In that way we should be preserving the state of the NHS as it is now. A tendency which has become more obvious in the recent past is for Opposition Members to create a political language when talking about such things as the National Health Service, education, insurance schemes and other aspects of our life. It seems that they want to see a clear divide between the elitist sections of our community and those who depend on the public sector for the provision of such services.
There is no doubt in my mind that the new clause will begin to deal with the

total argument concerning the NHS. It will begin to deal with the principles that have been argued by my hon. Friends. There is a political idealogy involved in advancing the service and not preserving it. We wish to advance it to new levels. That is what is needed, and that is what was anticipated when the service was set up. There has been a detrioration in the National Health Service and, as has been clearly demonstrated by my hon. Friends today, if private medicine is allowed to continue as at present it will have a detrimental effect on the service.
We are talking about resources which ought to be made available to the mass of the people in this country. Those who are opposed to that view argue that, because they are able to afford private medicine and education, they can abrogate their responsibilities for the standards of health and education in the public sector. In those circumstances, it is clear that we would have a deteriorating National Health Service.
My hon. Friend the Member for Barking (Miss Richardson) has made clear in her reference to the resources already planned for the private sector that we are talking not about a few hospitals and few beds but about resources which will have a direct effect in the short term and an even more dangerous effect in the longer term on the NHS. For that reason, we should resist any attempt to continue the present position of private medicine and the NHS operating under the same umbrella.
Some Opposition Members have argued about the value and efficiency of consultants working with both private and NHS patients under the same roof. The fact is that NHS hospitals provide operating theatres and consulting rooms which would not be available outside the NHS. Preparations for the private provision of these facilities are being made now, and that is one reason why some people are seeking a delay in the implementation of the phasing out of pay beds.
We have expressed our grave concern about the Bill, and it is our intention to make clear that the present situation should not remain unaltered. New Clause 2 establishes that we support the continuance of the National Health Service on the basis that the service shall be


made available to all at the time and place it is needed.

8.30 p.m.

Dr. Gerard Vaughan: Once again the gauntlet is down for the Secretary of State, not only from this side but from his own Back Benchers. Once again we have seen him in a position which is becoming all too familiar where virtually every speaker from the Government side has been against what the right hon. Gentleman is doing.
Not for the first time, I find myself following soon after a speech of the hon. Member for Ormskirk (Mr. Kilroy-Silk). He made a most vicious and misleading speech. He is perfecting the technique of coming into the Chamber late in a debate, making an appalling speech full of vindictiveness and then walking out. I deplore that kind of action. It makes me wonder what kind of past the hon. Member has experienced that he should be so blatantly against every part of establishment and security in this country.
The hon. Member for Ormskirk believes that a flow of words makes the truth. He has no idea of how the majority of people in the NHS feel about the work they do and about the Bill. I am talking not only of doctors and nurses but about the majority of porters, ward maids, technicians and other people whom I meet.
One of the sad things about the Bill has been not only that Labour Members disagreed with us—we expected that—or that their contributions ranged from the rather whimsical ignorance of the hon. Member for Brent, South (Mr. Pavitt) to the vicious comments about consultants made by the right hon. Lady the Member for Blackburn (Mrs. Castle), but that speech after speech has demonstrated an appalling gap in understanding between what Labour Members think goes on in the NHS and what actually occurs. They have been describing a National Health Service that I have not come across.
The people I meet are overworked, dedicated people struggling to make do with diminished resources. Only the other day I met a surgeon who could not get

funds to replace the basic instruments that he needs for his job.
We are talking about people who have looked after sick children, seen men and women in the last minutes of their lives and dealt with people who are in great pain. How can the right hon. Member for Blackburn say that that kind of person would turn his mind to making a little extra financial benefit by putting a patient through a private rather than a free bed? In my working life, my experience has been that doctors endeavour to provide the services for which patients ask. If patients want private care, the doctors will try to provide it. If the patients want other facilities, the doctors will try to provide them.
I have not come across the coercion and dishonesty to which the hon. Member for Aberdeen, North (Mr. Hughes) referred in his quite disgraceful remarks when he said that doctors had always been ready to play politics with their patients' lives. That is an absolute travesty of what goes on. It is this gap between what Labour Members have said in the debate and the reality of what goes on that I find so appalling.

Mr. Lomas: Will the hon. Gentleman give way?

Dr. Vaughan: The hon. Member for Rochdale (Mr. Smith) was right when he said that there was a widespread feeling within the National Health Service that freedom was at stake—

Mr. Lomas: I am trying to help the hon. Gentleman. Will he give way?

Dr. Vaughan: —not freedom to make money, but freedom to choose the kind of treatment most suited to the patient.

Mr. Lomas: In my speech, which the hon. Gentleman did not hear because he was not present—which was most regrettable—I was arguing in the nation's interests for the good of people who go into hospital. New Clause 2, so eloquently moved by my hon. Friend the Member for Brent, South (Mr. Pavitt) proposes that we should continue with the existing system but that by 1980 we should phase out private beds in the National Health Service. What is wrong with that? Why cannot the Opposition agree? I am sorry that they missed my 12-minute speech.

Mr. Deputy Speaker (Sir Myer Galpern): Order. I hope that this intervention will not be used for the purpose of making another speech.

Dr. Vaughan: The hon. Member for Huddersfield, West (Mr. Lomas) is mistaken. Not only was I present during his speech, but I listened with interest to the whole of it. I remember thinking how persuasive the hon. Gentleman was and how appreciative he was of his recent experience of the National Health Service. I was pleased to see him back in the Chamber.
We deplore that at a time of great national economic crisis we should be wasting our time on a Bill which not only will cost more money to the National Health Service and cause it to lose fees but is a petty and vicious political act at a time when so much needs to be done within the NHS.
I associate myself entirely with the remarks made by my hon. Friends the Members for Canterbury (Mr. Crouch) and Ealing, Acton (Sir G. Young) about the great needs within the service.
The hon. Member for Rochdale said that there is a widespread feeling, whether we agree with it or not, within the National Health Service that freedom is at stake. That is not the freedom to charge fees, but the freedom to choose the kind of treatment that one feels is most suited to a patient. It is the freedom to practise professional skills in the way they have been taught.
One striking feature in Committee was the way in which my hon. Friends were constantly able to draw on practical experience from right across the country, whereas Government supporters were generally content to talk in generalities and ideology.
I have here a letter from Kent in which the writer says:
This Government is attempting to nationalise our skills. It will lead to a disgruntled profession unwilling to continue to work the NHS treadmill. It will also lead to grave dangers for the old, the inadequate and the inconvenient.
That is very true. Sadly, the Bill will cause extensive damage to the care of patients. That is what we deplore about it.
The same person says:
I have myself cooked, made beds, swept floors, typed letters, put patients on to empty

bed-pans, stoked boilers, pushed trolleys, but I doubt if any member of NUPE or CoHSE could do the work that I do. If I choose to ration or withdraw my skill no one will be better off.
That is the sort of dilemma that is being faced by people.
To the hon. Member for Nelson and Colne (Mr. Hoyle) I say that it is not from the Conservatives that support for industrial action has come. We have consistently said that we deplore, are against and cannot support industrial action in the health field, and we have called on the Secretary of State and his colleagues to say that they deplore it equally—but we hear that from them in a very muted voice in times of crisis.
The hon. Member for Nelson and Colne is obviously out of touch with many of his union's members. Did he not know that one of the CoHSE branches produced a 12-point charter for the future of the NHS? Point 5 of that charter says that abuses are to be deplored and that professional conduct must be regulated, and point 11 says that the phasing out of pay beds is inappropriate where this would result in the lowering of standards of patient care. Is the hon. Gentleman unaware that at the NALGO annual conference this year there was a number of resolutions in favour of keeping pay beds? I have some of them in front of me. They are from Wigan, Kent and Warwickshire. They were defeated on a very narrow margin indeed. Therefore, it is absolute rubbish for the hon. Gentleman to say that he speaks for the majority of the union members.
My right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin) has stated clearly why the Opposition are opposed to the Bill and why we think that even now, and especially in the present economic situation, the Government should drop it. We believe that it would be far better, even now, to refer the question of pay beds to a Royal Commission. It would make great sense and it would bring peace and harmony back into the NHS.

Mr. Flannery: Nothing of the kind.

Dr. Vaughan: While we had expected in Committee to find that the Government and their supporters did not agree with us about withdrawing the Bill or


amending it widely, we did not expect to find that the Government had not thought through the Bill's implications. I question the Government's competence over the Bill. In this Chamber we have a right to expect legislation to be well thought out and capable of being applied properly. That is not the case with this Bill. It was repeatedly demonstrated in Committee that the Government had not done their home work before bringing the Bill before us. We know why the Bill was brought forward in a rush. We know why it was left until late in the Session. We know all the problems that the Government mounted for themselves. However, that is not justification for producing a faulty Bill.
We came across the first problem when discussing the composition of the board —five very important independent people. There was to be a chairman; that was agreed. There were to be two professional representatives; that was agreed. Two other people were to represent interested parties. From where will they come? Who will they be? Will patients be represented on this board? We do not know. We could get no straight answer on this question from the Secretary of State. It has all been left to the future.
8.45 p.m.
Following speech after speech from the right hon. Member for Blackburn saying how much these beds were needed and how they would release further facilities—we have heard it again in the debate today—we did not expect to find, as we did in Committee, that in the majority of cases these beds will not be available for patients. We already have an example at University College Hospital, where the private beds released have gone over to administration. There are many other examples of that in other parts of the country.
It is becoming apparent to many members of the unions that they have mounted a wrong horse on this matter because, instead of reducing unemployment in the health field, the Bill and its proposals will increase unemployment. We already see the prospect of nurses, porters, technicians and ward maids being thrown out of work.
The Secretary of State spoke in Committee about the size of staff which would be needed and he used it as a justification for restricting the size of private hospitals. When we came to it in Committee, we discovered that his figures were a fantasy, based not on reality, as our figures were, but on a theoretical model. That was the way the right hon. Gentleman mounted his argument in favour of licensing each private unit. I have a long list of other inadequacies, but in view of the hour I will not go through all of them.
We were told that consultation had taken place, and we heard that again this evening. The public knowledge and truth of the matter is that regular, proper consultation has not taken place. The only real consultation which took place started during the time of the Committee. Even then we were assured that the question of beds being phased out would be discussed right down to hospital level.
Only yesterday, however, I got a letter from the chairman of the hospital area in Cambridgeshire, which will be particularly affected, saying that the consultations have been an absolute travesty and that all the authority has received so far is a formal circular, to which it replied but got no answer other than an acknowledgement. It simply got a letter saying that the Bill had now passed through Committee. Without proper consultation, it is an absolute travesty of what ought to have happened. It is no wonder that the health profession feels thwarted and frustrated by what it hears and by what is going on.
The Government must deal with their own Back Benchers in respect of New Clause 2. That is not for us. We leave their problems to them. Our view is quite clear. We believe that at a time like this we should not proceed with the Bill, and we shall vote in favour of New Clause 4.

Mr. Ennals: I was fascinated that in his last sentence the hon. Member for Reading, South (Dr. Vaughan) actualy reached the amendment that we are debating. He debated a number of other amendments which we shall come to later, and made a thunderous attack on the Government's handling of the Bill.
I would remind him that the last time we discussed the Bill in this House was


on 20th July when we had a timetabling motion. Had we not had that time-tabling motion we would not have had detailed consideration in Committee for 29 sittings lasting 74 hours until we were able, even with one sitting over at the end which we did not need, to go right through the Bill and would not now have two days on Report. The one advantage of having two days on Report is that we have been able to have a very long debate on one group of amendments.
If we did not know it from the Committee proceedings, we know from what has happened in the House that, whatever differences there may be between the position which I shall take and that of my hon. Friends, the real division is absolutely clear between the two sides of the House. We have heard arguments about what is called the defence of freedom. In fact, they have been arguments for the defence of privilege. On this side it has been said that there should be a terminal date. As some of my hon. Friends say, whatever differences there may be between us, we are all united on our side in our determination that the time has come, nearly 30 years after the health service was established to separate the private from the public sector.
When I hear Conservative Members quoting Nye Bevan in this respect it makes me physically sick. I own only one personal portrait and that is of Nye Bevan. I never thought that I would have the privilege of taking it down into the office of Secretary of State for Social Services. He stands there on my desk and looks at me. The thought that, when he introduced the health service, he would have wished to defend the right of the private sector to remain within the public sector of the NHS is absolutely ludicrous. He was obliged to enter into a compromise at that time. I have no doubt that, had he been Secretary of State today, Nye would have been standing with my right hon. Friend and myself in introducing a measure like this. It might have been a measure which would not have been the sort of compromise which this one is.
I want to pay a tribute to my right hon. Friend the Member for Blackburn (Mrs. Castle). She has been attacked in her absence and in her presence during

this debate. I must pay to her a tribute which, I believe, should be respected in all quarters of the House. No Secretary of State has stood more firmly by the principles of the National Health Service or has fought more effectively for resources for the National Health Service. She may sometimes criticise me, but I will not stand here and listen to criticisms of her integrity in the way in which she has tried to do her job.
I should also like, as no one has yet done, to defend the role of the noble Lord, Lord Goodman. I do not necessarily agree that the compromise reached was the best. That is not for me to decide. It was a compromise genuinely negotiated at a time when the NHS was in sore sickness. It was agreed—it was a fair agreement—that the proposals put forward by Lord Goodman, if they were found by the professions to be acceptable as a basis of legislation, would be put into effect and legislated by the Government on that basis. That was the bargain. It was put to the professions, it was accepted that that should be a basis for legislation.
Our side of the bargain is to stand by it. That my right hon. Friend has loyally done, and she has supported me in my position in Committee. l therefore want to make it clear to Conservative Members that we shall not abandon or postpone the implementation of the Bill. Let there be no question about that.
The hon. Member for Rochdale (Mr. Smith) and the hon. Member for Ealing, Acton (Sir G. Young) referred to the irrelevance of the Bill to the country's economic needs. The Bill not not introduced to deal with the nation's economy, but it is very relevant in terms of the needs of the health service.
What I find difficult to understand is that hon. Members opposite do not see the strength of principle which is held not only by my right hon. and hon. Friends but by those who work in the health service. I was surprised to hear the hon. Member for Reading, South imply—whether he based it on some sort of survey or not I do not know—that those who work in the health service are somehow united with the consultants in thinking that things should stay as they are. That is just not so. If this Government were to decide, which I can say we will


not, to postpone the implementation of the Bill or to refer it to the Royal Commission, there would be great rifts within the health service. It is part of my responsibility to be concerned with the morale of the health service, with the way in which the different professions work together within it—whether they be consultants, nurses, technicians or porters—in making their contribution to tile health service.
The Opposition seem to think that somehow or other all will be peace and light if we drop the Bill. They do not realise that for some of those who work within the health service it is offensive and a challenge to their principles to be involved in a service which makes special provision for those who can pay and does not simply provide for the generality of the nation's needs. It would be greatly against the interests of the health service if the Bill were dropped or the Opposition's proposals were carried out.
The Opposition have referred to the unions, but I have not heard any hon. Member mention the Royal College of Nurses which is as much committed to the phasing out of pay beds as the unions. The members of the Royal College have said that to me and they welcome our stand on the issue. I, too, spent part of the summer in a National Health Service hospital, and I found a different attitude from that described by members of the Opposition.
The right hon. Member for Wanstead and Woodford (Mr. Jenkin) quoted extracts from an interview which I gave. I do have a very heavy responsibility to strengthen and improve the National Health Service and to improve the morale within it. I do not go along with those who make either particular or generalised criticisms against sections of the health service, I do not accept some of the statements made by my hon. Friends against consultants in a general sense, although some of the accusations apply individually. I also totally dissociate myself from criticisms of irresponsible union action. Most of those who work within the health service genuinely want it to succeed and I have a heavy responsibility to try to bring together the different strands of the service to ensure that they work together as a team and get away from the confrontation from which the service has been suffering.

Mr. Lomas: Will my right hon. Friend stop trying to convince the Opposition because we know they will not accept the proposals? The hon. Member for Reading, South (Dr. Vaughan) made a terrible speech. Will my right hon. Friend try instead to convince us why the Government should not accept New Clause 2?

Mr. Ennals: If my hon. Friend will be patient I shall seek to do precisely that and I hope that I shall succeed in convincing him.
One suggestion in the argument for postponement was that the matter should be put to a Royal Commission, but my hon. Friend the Member for Aberdeen. North (Mr. Hughes) was right when he said that the time had come to end the argument and the idea that the health service would be better if the issue were postponed. Not at all. It is the right decision to be taken now and it is right that we should proceed to implementation and then get back to the task of making improvements in relationships.
The hon. Member for Ealing, Acton referred to a sinking, bankrupt National Health Service. It is no such thing. There is much exaggeration about cuts in the service. Everyone knows that there are not nearly enough funds to meet the needs of the service, but I doubt if there ever were. While we all recognise that the rate of growth and expenditure has been reduced there is still increased expenditure on the National Health Service. Too many statements are lightly made, without examination, and they may lead to despondency and concern.
9.0 p.m.
The right hon. Member for Wanstead and Woodford referred to an alleged 20 per cent. cut in surgical beds at the West Middlesex Hospital. The fact is that there has been a temporary closure of 20 per cent. of the surgical beds there because of shortage of nursing staff. It is a difficulty of recruiting suitable staff. It is not a cut-back as an economic restraint. I have been assured today that it is hoped that the beds will be staffed and opened again within a month. The spreading of such rumours about the NHS can do very much damage, and. as was the case yesterday, the right hon. Gentleman would do better to ask for


information first instead of making such statements in the House of Commons.

Sir George Young: I hope that the right hon. Gentleman is not implying that the cases I listed in my speech were imagined. Will he acknowledge that these cases have been announced by the North-West Thames Regional Health Authority?

Mr. Ennals: I am not suggesting that there are not closures, in some cases of hospitals and in some cases of units, but if one looks across the country one sees that it is inevitable that when one opens new hospitals there will be closures of old. The hon. Member for Ealing, Acton will recognise, coming as he does from London, that one of the things the Government are trying to achieve is to adjust the imbalance between the heavy preponderance of resources made available to the Thames Regions at the expense of other parts of the country. It is difficult for area health authorities and regional health authorities to carry this process through, but it has to be done in order to ensure that we have greater fairness across the land in the availability of resources.

Mr. Patrick Jenkin: I have refreshed my memory about the information given to me concerning the West Middlesex Hospital. The story I have been told is quite different from the right hon. Gentleman's. It is that the area health authority is holding vacant a number of posts in order to avoid redundancies when other hospitals within its remit are closed later in the year. It is a financial reason. The authority is having to close down the beds. I will examine the information which the right hon. Gentleman has given, but it is inconsistent with what I was told by a leading consultant at the hospital.

Mr. Ennals: My information comes from the area health authority. In view of the nature of this debate, I do not know whether the leading consultant to whom the right hon. Gentleman has referred wishes perhaps to put information into his head in order to influence the debate, but as I have said, I have had my information from the authority itself, which is responsible for appointments and for the allocation of resources. I say to the Opposition that I shall not

accept their proposal for a postponement or deferment of part of the Bill.
I turn now to New Clause 2. I have a lot of sympathy with the argument of my hon. Friend the Member for Brent, South (Mr. Pavitt). He wants to get the job done quickly—I understand that—but he will not expect me to accept New Clause 2. I shall not accept it for precisely the same reason as was put by my right hon. Friend the Member for Blackburn. A bargain was struck, and a bargain is a bargain.
Throughout the 29 sittings of the Stand-Committee the Opposition sought to undermine that bargain, but we pledged ourselves to put that bargain before the House. It was put before the consultants. There was a commitment from the Prime Minister. The bargain stands.
One could debate on another occasion whether every bit of the bargain was all right. I am not claiming that my right hon. Friend the Member for Blackburn would say that she was wholly satisfied with the bargain, but that is not the question tonight. It was a bargain. If I were to say now that I am withdrawing from that bargain, from the central principle within it, which was not that there should be a terminal date but that there should be strict criteria on which an independent board could arrive at a decision, I would be betraying both the bargain and my trust to this House. However, I wish to give my hon. Friends some assurances.

Mr. Dennis Skinner: When?

Mr. Ennals: Now.
The assurances that I give are that the objectives of the Bill are set out very clearly, and anyone who agrees to be a member of the board will be under an obligation to ensure the carrying through of the purposes of the Bill, which are to phase pay beds out of the National Health Service. That will be the board's task and the task of all its members.
I believe that it would be a mistake to tie the board's hand by imposing a particular date. I have no doubt that the board will have made considerable progress by 1980. For all I know, it may have completed the task by 1980. Certainly, I would guess, it will have made more rapid progress in London than in


other parts of the country, in the very nature of the situation.
This legislation is designed not to protect pay beds within the National Health Service. It is designed to phase them out, and it carries out absolutely to the letter the commitment made in two election manifestos. We said that we would phase out pay beds. That is what we are about to do, and, while I have every sympathey for the views my hon. Friends have expressed, I believe that those who will form the membership of the board will sense the feeling that the task must not be done too slowly. There will be a recognition of what hon. Members have said.
I hope, however, that my hon. Friends will not vote for the new clause. I hope that they will accept that, as Secretary of State, I have been fulfilling my responsibilities properly in maintaining a bargain which was struck, which was announced in the House, which was inscribed in the Bill and which has been carried through the Standing Committee.

Mr. Pavitt: I shall be brief in exercising my right of reply to the debate, and I greatly welcome some of the assurances given by my right hon. Friend.
I was disappointed by the speech of the hon. Member for Rochdale (Mr. Smith). I had hoped that he would lend his weight in support of my new clause, having heard him speak previously on health matters, when he looked to a much wider horizon. However, it was not to be. As for the hon. Member for Galloway (Mr. Thompson), I hope that he will have second thoughts. He came three-quarters of the way towards my New Clause 2, and I hope that he will come the rest of the way within the final few minutes.
As for the right hon. Member for Wan-stead and Woodford (Mr. Jenkin), who opened the debate on New Clause 4, I think that he always finds it difficult to dissociate himself from the Treasury. Every time he makes a speech on the National Health Service, I recall him in his previous incarnation as Chief Secretary to the Treasury. Invariably we have from him a Treasury-type speech, and he did not disappoint us today. The hon. Member for Galloway put very precisely the point which the right hon. Gentleman was making—that we should keep the

matter in cold storage under New Clause 4, because in two years' time we may have a Tory victory, in which event it would stay in cold storage for all time. That, therefore, is one of the reasons why my hon. Friends and I shall resist New Clause 4.
The hon. Member for Reading, South (Dr. Vaughan) spoke as a consultant of Guy's Hospital and with a good deal of knowledge. However, I must tell him that this was the first occasion in any debate on the National Health Service—I have attended every one in the past 16 years—when anyone has stated that I speak from ignorance of the service. I assure the hon. Gentleman that, although he may have a subconscious urge—he knows all about the subconscious through his speciality—always to see the National Health Service in terms of what doctors want and request, we on these Benches speak for the patients, and that is always our approach.
More in sorrow than in anger, I assure my right hon. Friend, as I said when moving New Clause 2, that I accept both his position and that of my right hon. Friend the Member for Blackburn (Mrs. Castle). We on this side are well aware of and have very sympathy and understanding for the stand which he takes. He struck a bargain. But we did not strike a bargain, and, so far as we are concerned, when we have to go into the Lobby tonight, as I am afraid we shall, we shall not do it in any attempt to undermine either his authority or his purpose.
We know that if our very reasonable New Clause 2 were implemented, before the due date came there would have been seven reports to the House as a result of the efforts which my right hon. Friends the present Secretary of State and the Member for Blackburn made in including their provisions in the Bill. Therefore, there would be eternal vigilance.
We must press the clause to a Division to show that there is a strong body of opinion on the Labour Benches and outside the House that feels it imperative to include a date, even though it is four years away, otherwise the Bill will be too open-ended. Should there be a change of Government or Minister, or a number of other changes, we could see the thwarting of the purposes to which I am sure my right hon. Friend the Secretary


of State is just as devoted as I and my right hon. Friend the Member for Blackburn are. Therefore, I ask as many of my right hon. and hon. Friends as feel able to join me in the Lobby to do so.

Question accordingly negatived.

Question put, That the clause be read a second time:—

The House divided: Ayes 50, Noes 144.

Division No. 313.
AYES
[9.11 p.m.


Allaun, Frank
Heffer, Eric S.
Rooker, J. W.


Anderson, Donald
Hoyle, Doug (Nelson)
Rose, Paul B.


Buchan, Norman
Hughes, Robert (Aberdeen [...])
Short, Mrs Renée (Wolv NE)


Callaghan, Jim (Middleton &amp; P)
Hughes, Roy (Newport)
Sillars, James


Carmichael, Neil
Kilroy-Silk, Robert
Silverman, Julius


Clemitson, Ivor
Lambie, David
Skinner, Dennis


Colquhoun, Ms Maureen
Lestor, Miss Joan (Eton &amp; Slough)
Spearing, Nigel


Cook, Robin F. (Edin C)
Litterick, Tom
Taylor, Mrs Ann (Bolton W)


Corbett, Robin
Lomas, Kenneth
Thomas, Dafydd (Merioneth)


Davies, Bryan (Enfield N)
Loyden, Eddie
Thomas, Ron (Bristol NW)


Edge, Geoff
McDonald, Dr Oonagh
Thorne, Stan (Preston South)


Evans, Gwynfor (Carmarthen)
McMillan, Tom (Glasgow C)
Wigley, Dafydd


Evans, Ioan (Aberdare)
Madden, Max
Wise, Mrs Audrey


Fernyhough, Rt Hon E.
Maynard, Miss Joan
Woof, Robert


Flannery, Martin
Mendeison, John



George, Bruce
Noble, Mike
TELLERS FOR THE AYES:


Grocott, Bruce
Roberts, Gwilym (Cannock)
Mr. Laurie Pavitt and


Hatton, Frank
Roderick, Caerwyn
Miss. Jo Richardson.




NOES


Archer, Peter
Fletcher, Ted (Darlington)
Morris, Charles R. (Openshaw)


Ashton, Joe
Foot, Rt Hon Michael
Moyle, Roland


Atkins, Ronald (Preston N)
Ford, Ben
Murray, Rt Hon Ronald King


Atkinson, Norman
Forrester, John
Ogden, Eric


Bagier, Gordon A. T.
Eraser, John (Lambeth, N'w'd)
Orbach, Maurlce


Bain, Mrs Margaret
Freeson, Reginald
Orme, Rt Hon Stanley


Barnett, Guy (Greenwich)
Golding, John
Pardoe, John


Bates, Alf
Gould, Bryan
Park, George


Beith, A. J.
Gourlay, Harry
Parker, John


Benn, Rt Hon Anthony Wedgwood
Grant, George (Morpeth)
Pendry, Tom


Bishop, E. S.
Grant, John (Islington C)
Panhaligon, David


Blenkinsop, Arthur
Gray, Hamish
Reid, George


Boardman, H.
Hamilton, James (Bothwell)
Roberts, Albert (Normanton)


Booth, Rt Hon Albert
Hardy, Peter
Robinson, Geoffrey


Bray, Dr Jeremy
Harper, Joseph
Roper, John


Brown, Hugh D. (Provan)
Harrison, Walter (Wakefield)
Ross, Stephen (Isle of Wight)


Brown, Robert C. (Newcastle W)
Henderson, Douglas
Ross, Rt Hon W. (Kilmarnock)


Buchanan, Richard
Hooson, Emlyn
Rowlands, Ted


Campbell, Ian
Howell, Rt Hon Denis (B'ham, Sm H)
Ryman, John


Cant, R. B.
Howells, Geraint (Cardigan)
Silkin, Rt Hon S. C. (Dulwich)


Castle, Rt Hon Barbara
Hughes, Rt Hon C. (Anglesey)
Small, William


Chalker, Mrs Lynda
Hunter, Adam
Smith, Cyril (Rochdale)


Cocks, Michael (Bristol S)
Hutchison, Michael Clark
Smith, John (N Lanarkshire)


Cohen, Stanley
Irving, Rt Hon S. (Dartford)
Snape, Peter


Coleman, Donald
Jackson, Miss Margaret (Lincoln)
Spriggs, Leslie


Conlan, Bernard
Jay, Rt Hon Douglas
Stewart, Ian (Hitchin)


Cox, Thomas (Tooting)
Jenkins, Hugh (Putney)
Stoddart, David


Craigen, J. M. (Maryhill)
John, Brynmor
Strang, Gavin


Cronin, John
Johnson, James (Hull West)
Swain, Thomas


Crowther, Stan (Rotherham)
Jones, Alec (Rhondda)
Thompson, George


Cryer, Bob
Jones, Barry (East Flint)
Tinn, James


Cunningham, G. (Islington S)
Jones, Dan (Burnley)
Urwin, T. W.


Cunningham, Dr J. (Whiteh)
Lamond, James
Wainwright, Edwin (Dearne V)


Davidson, Arthur
Lewis, Ron (Carlisle)
Walker, Harold (Doncaster)


Davies, Denzil (Llaneill)
Lipton, Marcus
Walker, Terry (Kingswood)


Davies, Ifor (Gower)
Lyons, Edward (Bradford W)
Weetch, Ken


Deakins, Eric
MacCormick, Iain
Welsh, Andrew


Dempsey, James
McElhone, Frank
White, Frank R. (Bury)


Doig, Peter
MacFarquhar, Roderick
White, James (Pollock)


Dormand, J. D.
McGuire, Michael (Ince)
Willey, Rt Hon Frederick


Douglas-Hamilton, Lord James
MacKenzie, Gregor
Wilson, Alexander (Hamilton)


Duffy, A. E. P.
Mackintosh, John P.
Wilson, Gordon (Dundee E)


Dunn, James A.
Mahon, Simon
Wilson, William (Coventry SE)


Eadie, Alex
Marks, Kenneth
Young, David (Bolton E)


Edwards, Robert (Wolv SE)
Marquand, David
Young, Sir G. (Eating, Acton)


Ellis, John (Brigg &amp; Scun)
Marshall, Dr Edmund (Goole)



Ennals, David
Marshall, Jim (Leicester S)
TELLERS FOR THE NOES:


Ewing, Harry (Stirling)
Meacher, Michael
Mr. A. W. Stallard and


Faulds, Andrew
Miller, Mrs Millie (Ilford N)
Mr. Ted Graham.


Fletcher, L. R. (Ilkeston)

New Clause 4

COMMENCEMENT OF PART II OF ACT

Part II of this Act shall come into force on 31st December 1978.—[Mr. Patrick Jenkin.]

Brought up, and read the First time.

Question accordingly negatived.

Mr. Patrick Jenkin: I beg to move, That the clause be read a Second time.

Question put, That the clause be read a Second time:—

The House divided: Ayes 148, Noes 182.

Division No. 314.]
AYES
9.23 p.m.


Atkins, Rt Hon H. (Spelthorne)
Hall, Sir John
Newton, Tony


Awdry, Daniel
Hall-Davis, A. G. F,
Nott, John


Beith, A. J.
Hamilton, Michael (Salisbury)
Page, Rt Hon R. Graham (Crosby)


Bell, Ronald
Hannam, John
Paisley, Rev Ian


Bennett, Or Reginald (Fareham)
Harvie Anderson, Rt Hon Miss
Pardoe, John


Berry, Hon Anthony
Hayhoe, Barney
Parkinson, Cecil


Biffen, John
Hicks, Robert
Panhaligon, David


Blaker, Peter
Hooson, Emlyn
Percival, Ian


Body, Richard
Hordern, Peter
Powell, Rt Hon J. Enoch


Boscawen, Hon Robert
Howells, Geraint (Cardigan)
Prior, Rt Hon James


Brocklebank-Fowler, C.
Hunt, David (Wirral)
Pym, Rt Hon Francis


Brown, Sir Edward (Bath)
Hunt, John (Bromley)
Raison, Timothy


Buchanan-Smith, Alick
Hurd, Douglas
Rathbone, Tim


Buck, Antony
Hutchison, Michael Clark
Rees, Peter (Dover &amp; Deal)


Bulmer, Esmond
James, David
Rifkind, Malcolm


Burden, F. A.
Jenkin. Rt Hon P. (Wanst'd &amp; W'df'd)
Rippon, Rt Hon Geoffrey


Carlisle, Mark
Johnson Smith, G. (E Grinstead)
Roberts, Wyn (Conway)


Chalker, Mrs Lynda
Jopling, Michael
Ross, Stephen (Isle of Wight)


Clark, Alan (Plymouth, Sutton)
Kaberry, Sir Donald
Rost, Peter (SE Derbyshire)


Clarke, Kenneth (Rushclifle)
Kershaw, Anthony
Sainsbury, Tim


Clegg, Walter
Kilfedder, James
Scott, Nicholas


Cooke, Robert (Bristol W)
Kimball, Marcus
Shaw, Giles (Pudsey)


Cope, John
King, Tom (Bridgwater)
Shepherd, Colin


Cordle, John H.
Kitson, Sir Timothy
Shersby, Michael


Cormack, Patrick
Knight, Mrs Jill
Silvester, Fred


Costain, A. P.
Knox, David
Sims, Roger


Craig, Rt Hon W. (Belfast E)
Latham, Michael (Melton)
Sinclair, Sir George


Crouch, David
Lawrence, Ivan
Smith, Cyril (Rochdale)


Dean, Paul (N Somerset)
Le Marchant, Spencer
Speed, Keith


Dodsworth, Geoffrey
Luce, Richard
Spence, John


Douglas-Hamilton, Lord James
McCrindle, Robert
Sproat, Iain


Dunlop, John
McCusker, H.
Stanbrook, Ivor


Eden, Rt Hon Sir John
Macfarlane, Neil
Stewart, Ian (Hitchin)


Fairbairn, Nicholas
Marshall, Michael (Arundel)
Stradling Thomas, J.


Fairgrieve, Russell
Marten, Neil
Taylor, R. (Croydon NW)


Fell, Anthony
Mather, Carol
Taylor, Teddy (Cathcart)


Fisher, Sir Nigel
Maudling, Rt Hon Reginald
Tebbit, Norman


Fletcher-Cooke, Chartes
Maxwell-Hyslop, Robin
Vaughan, Dr Gerard


Fookes, Miss Janet
Meyer, Sir Anthony
Wakeham, John


Forman, Nigel
Miller, Hal (Bromsgrove)
Walder, David (Clitheroe)


Fowler, Norman (Sutton C'f'd)
Mills, Peter
Wall, Patrick


Gardiner, George (Reigate)
Mitchell, David (Basingstoke)
Weatherill, Bernard


Gilmour, Rt Hon Ian (Chesham)
Molyneaux, James
Whitelaw, Rt tHon William


Gow, Ian (Eastbourne)
Monro, Hector
Winterton, Nicholas


Gower, Sir Raymond (Barry)
Moore, John (Croydon C)
Young, Sir G. (Ealing, Acton)


Grant, Anthony (Harrow C)
More, Jasper (Ludlow)
Younger, Hon George


Gray, Hamish
Morgan-Giles, Rear-Admiral



Grieve, Percy
Morrison, Hon Peter (Chester)
TELLERS FOR THE AYES


Griffiths, Eldon
Mudd, David
Mr. Jim Lester and


Grist, Ian
Neave, Airey
Mr. W. Benyon


Grylls, Michael
Neubert, Michael





NOES


Allaun, Frank
Brown, Robert C. (Newcastle W)
Craigen, J. M. (Maryhill)


Anderson, Donald
Buchan, Norman
Cronin, John


Archer, Peter
Buchanan, Richard
Crowther, Stan (Rotherham)


Ashton, Joe
Callaghan, Jim (Middleton &amp; P)
Cryer, Bob


Atkins, Ronald (Preston N)
Campbell, Ian
Cunningham, G. (Islington S)


Atkinson, Norman
Cant, R. B.
Cunningham, Dr J. (Whiteh)


Bagier, Gordon A. T.
Carmichael, Neil
Davidson, Arthur


Bain, Mrs Margaret
Castle, Rt Hon Barbara
Davies, Bryan (Enfield N)


Barnett, Guy (Greenwich)
Clemitson, Ivor
Davies, Denzil (Llanelli)


Bates, Alf
Cocks, Michael (Bristol S)
Davies, Ifor (Gower)


Benn, Rt Hon Anthony Wedgwood
Cohen, Stanley
Deakins, Eric


Bishop, E. S.
Coleman, Donald
Dempsey, James


Blenkinsop, Arthur
Colquhoun, Ms Maureen
Doig, Peter


Boardman, H.
Conlan, Bernard
Dormand, J. D.


Booth, Rt Hon Albert
Cook, Robin F. (Edin C)
Duffy, A. E. P.


Bray, Dr Jeremy
Corbett, Robin
Dunn, James A.


Brown, Hugh D. (Provan)
Cox. Thomas (Tooting)
Eadie, Alex




Edge, Geoff
Jones, Barry (East Flint)
Rooker, J. W


Edwards, Robert (Wolv SE)
Jones, Dan (Burnley)
Roper, John


Ellis, John (Brigg &amp; Scun)
Kilroy-Silk, Robert
Rose, Paul B.


Ennals, David
Lamble, David
Ross, Rt Hon W. (Kilmarnock)


Evans, Gwynfor (Carmarthen)
Lamond, James
Rowlands, Ted


Evans, Ioan (Aberdare)
Lester, Jim (Beeston)
Ryman, John


Ewing, Harry (Stirling)
Lewis, Ron (Carlisle)
Short, Mrs Renée (Wolv NE)


Faulds, Andrew
Lipton, Marcus
Silkin, Rt Hon S. C. (Dulwich)


Fernyhough, Rt Hon E.
Litterick, Tom
Sillars, James


Flannery, Martin
Lomas, Kenneth
Silverman, Julius


Fletcher, L. R. (Ilkeston)
Loyden, Eddie
Skinner, Dennis


Fletcher, Ted (Darlington)
Lyons, Edward (Bradford W)
Small, William


Foot, Rt Hon Michael
MacCormick, Iain
Smith, John (N Lanarkshire)


Ford, Ben
McDonald, Dr Oonagh
Snape, Peter


Forrester, John
McElhone, Frank
Spearing, Nigel


Fraser, John (Lambeth, N'w'd)
MacFarquhar, Roderick
Spriggs, Leslie


Freeson, Reginald
McGuire, Michael (Ince)
Stoddart, David


George, Bruce
Mackintosh, John P.
Strang, Gavin


Golding, John
McMillan, Tom (Glasgow C)
Swain, Thomas


Gould, Bryan
Madden, Max
Taylor, Mrs Ann (Bolton W)


Gourlay, Harry
Mahon, Simon
Thomas, Dafydd (Merioneth)


Grant, George (Morpeth)
Marks, Kenneth
Thomas, Ron (Bristol NW)


Grant, John (Islington C)
Marquand, David
Thompson, George


Grocott, Bruce
Marshall, Dr Edmund (Goole)
Thorne, Stan (Preston South)


Hamilton, James (Bothwell)
Marshall, Jim (Leicester S)
Tinn, James


Hardy, Peter
Maynard, Miss Joan
Urwin, T. W.


Harper, Joseph
Meacher, Michael
Wainwright, Edwin (Dearne V)


Harrison, Walter (Wakefield)
Mendelson, John
Walker, Harold (Doncaster)


Hatton, Frank
Morris, Charles R. (Openshaw)
Walker, Terry (Kingswood)


Heffer, Eric S.
Moyle, Roland
Weetch, Ken


Henderson, Douglas
Murray, Rt Hon Ronald King
Welsh, Andrew


Howell, Rt Hon Denis (B'ham, Sm H)
Noble, Mike
While, Frank R. (Bury)


Hoyle, Doug (Nelson)
Ogden, Eric
White, James (Pollock)


Hughes, Rt Hon C. (Anglesey)
Orbach, Maurice
Wigley, Dafydd


Hughes, Robert (Aberdeen N)
Orme, Rt Hon Stanley
Willey, Rt Hon Frederick


Hughes, Roy (Newport)
Park, George
Wilson, Alexander (Hamilton)


Hunter, Adam
Parker, John
Wilson, Gordon (Dundee E)


Irving, Rt Hon S. (Dartford)
Pavitt, Laurie
Wilson, William (Coventry SE)


Jackson, Miss Margaret (Lincoln)
Pendry, Tom
Wise, Mrs Audrey


Jay, Rt Hon Douglas
Reid, George
Woof, Robert


Jeger, Mrs Lena
Richardson, Miss Jo
Young, David (Bolton E)


Jenkins, Hugh (Putney)
Roberts, Albert (Normanton)



John, Brynmor
Roberts, Gwilym (Cannock)
TELLERS FOR THE NOES


Johnson, James (Hull West)
Robinson, Geoffrey
Mr. Ted Graham and


Jones, Alec (Rhondda)
Roderick, Caerwyn
Mr. A. W. Stallard

Question accordingly negatived.

New Clause 5

COMPENSATION FOR LOSS OF INCOME OR REDUCTION IN EARNING CAPACITY

'(1) Any person (whether or not a consultant) who was on 12th April 1975 employed whole-time or part-time in one or other of the National Health Services or concerned with the interest of patients of NHS hospitals who claims to have suffered significant loss or diminution of income, or reduction in his earning capacity, attributable to the passage of this Act may make a claim in respect thereof to the Board, and the Board shall consider such claim.

(2) If the Board is satisfied that any person making a claim under this section has suffered such loss or diminution of income, it should give notice thereof together with the Board's determination of the appropriate sum to be paid to compensate such persons, to the Secretary of State who shall thereupon compensate such persons accordingly.

(3) Notwithstanding any payment of compensation under this section, if the Board is satisfied that any person making a claim has suffered a reduction in his earning capacity it shall make a proposal to the Secretary of

State to secure that that person may obtain more advantageous conditions of service in his NHS employment, to such extent as the Board shall determine after hearing the representations of the claimant, and it shall be the duty of the Secretary of State to ensure that effect is given to such proposal'.—[Mr. Paul Dean.]

Brought up, and read the First tune.

Mr. Paul Dean: I beg to move, That the clause be read a Second time.
The clause deals with compensation for loss of income or reduction in earnings capacity. It will be recollected that this important subject was discussed briefly in Committee on two occasions. First, the individual case of a constituent was raised by my hon. Friend the Member for Ealing, Acton (Sir G. Young). The second time it was raised was on the last day of the sitting of the Committee, when I moved a similar new clause to this one.
It will be recollected that we had an extremely brief debate on this subject in Committee as it was the last day under the guillotine motion. We responded to


the Government's request to have rapid debates on the new clauses so that we could rise at lunch-time rather than continue in the afternoon.
We attach special importance to this subject since the debate was in Committee extremely brief. Another reason for our attaching importance to it is that following the brief debate in Committee there was a tie in the voting, seven Members voting in favour and seven against. The Chairman, as was entirely proper and in accordance with precedent, voted with the Ayes on the first occasion—namely, that the clause should be read a Second time—and, also according to precedent with the Noes when the Question was put that the clause be added to the Bill. It was for only a brief and fleeting moment that the principle of compensation was accepted.
It is partly for that reason that we are trying again on the Floor of the House. Another reason is that we feel that the answer we received from the Government was unsatisfactory and unsympathetic.
The object of the clause is simple and clear—namely, that if someone who works in the National Health Service suffers a significant loss of earnings or earning capacity as a result of the passage of this measure he should be offered compensation and better conditions of service. This is the "no detriment" principle, which I think will be accepted on both sides of the House. In particular, I hope that it will appeal to right hon. and hon. Members on the Government Benches. I hope that it will appeal to the right hon. Member for Blackburn (Mrs. Castle), whom I am glad to see in her place.
I remind the right hon. Lady of an answer she gave as Secretary of State at the end of last year. She said:
we appreciate that the principle of no detriment is a very good trade union principle".[Official Report, 1st December 1975; Vol. 901, c. 1268]
If the Government do not feel disposed to accept the clause, I hope that the right hon. Lady will speak in favour of it and, if necessary, record her vote in favour of it in due course.

Mrs. Castle: rose—

Mr. Dean: I am putting to the right hon. Lady and to the House that what is sauce for the trade unions should be sauce for the consultants. It is largely the part-time consultants who are most likely to suffer and who will need the assistance that is proposed in the clause.

Mrs. Castle: I hope that the hon. Gentleman will not give the House the impression that I was using "no detriment" in this context. He will be aware that the whole purpose of having a phased-out policy operated by the criteria of the independent board is for it to act as an alternative to the sort of compensation principle for which he is pressing and which I do not support.

Mr. Dean: I am disappointed to hear the right hon. Lady say that. Nothing in her intervention diminishes my argument that we have always attached considerable importance, as have trade unions, to ensuring that, if Governments change the rules under which people work so that they suffer as a result, the "no detriment" principle should apply and that the people should be compensated for any losses.
There are ample precedents inside and outside the NHS. There is a precedent in the 1946 Act which set up the National Health Service and there are other precedents in later National Health Service Acts. Why should not the principle apply here? Surely it is right that, if a Government alter the rules and people suffer as a result through no fault of their own, the Government should ensure that the individuals should be compensated for any loss. It is a simple but very important principle.
I am not proposing a blanket provision. It is carefully drawn, and each person would have to show the merit of his case. The provision will be available to anybody working in the NHS who feels that he has suffered as a result of the Bill, though it is most likely to apply to surgeons, anaesthetists and others using highly sophisticated equipment. One relevant example might be a consultant who at present does his private work in an NHS hospital where he does his National Health Service work. Under the Bill, that consultant would have to divide his time between the NHS hospital and an independent hospital where he would see his private patients. He


might feel that the extra travelling time and complications involved in such an arrangement would prevent his doing justice to both his private and his NHS patients, and he might decide for perfectly proper professional and ethical reasons to give up his private practice and work full time on NHS patients. The result could be a permanent loss of earning capacity.
Alternatively, a consultant might wish to change from a maximum part-time contract with the NHS to a part-time contract which allowed him the additional time needed properly to look after his private patients.
9.45 p.m.
The Government have a special obligation in these cases. The Bill will make it impossible, in some circumstances, for consultants to do both NHS work and private practice together. Indeed, in Committee the Government turned down a number of amendments designed to stop the phasing out of pay beds where alternative private facilities were not reasonably available. I suggest that there is here a clear obligation on the part of the Secretary of State to compensate on the basis of the "no detriment" principle, of past precedent and of his refusal to deal with this problem in other ways that were put forward in Committee.
It is important in these and other debates to consider the possible damaging and disturbing effect that the Bill could have on the National Health Service as a whole and on the attitude of consultants and others towards their future in the service. Unless staff, including consultants, feel reasonably secure, unless they feel that they can practise medicine without undue political interference and unless they feel that they can care for their patients without Big Brother breathing down their necks, they will take their talents elsewhere. They will emigrate to countries where they are appreciated. If they feel that there is to be one monopoly employer, that could be the last straw which could turn the present medical brain drain into a torrent.
I beg the Secretary of State to recognise these fears about maintaining the necessary skilled manpower in the NHS. That is the broad context in which I commend this comparatively modest and, I suggest, wholly reasonable proposition to the House.

The Minister of State, Department of Health and Social Security (Mr. Roland Moyle): I rise with some diffidence to plunge into the complexities of the Health Services Bill which has engaged the attention of most hon. Members in the Chamber for a considerable time.
The hon. Member for Somerset, North (Mr. Dean) moved the new clause with his characteristic courtesy and clarity, but I shall have to disappoint him by indicating that the Government do not accept it as being appropriate for the Bill.
The hon. Gentleman urged that what was sauce for the trade union goose should be sauce for the consultant gander. I take my stand on that principle. The Government are fully committed to compensation for loss of employment or office as such. It happened under reorganisation. That is totally different from what is proposed in the new clause. Despite the claims made by the hon. Gentleman for its careful drafting and the fact that it is not a blanket clause, it struck me as being rather vague and sweeping in that it would apply to anybody concerned with the interests of patients in NHS hospitals. It covers a wide class of people. It might, in the opinion of a court, bring in people who had an indirect connection with patients in NHS hospitals.
The clause proposes that, despite the fact that compensation could be paid or recommended by the board,
it shall make a proposal to the Secretary of State to secure that that person may obtain more advantageous conditions of service in his NHS employment".
I have never yet heard a trade union affiliated to the TUC argue that redundancy should be taken as an opportunity for possible promotion or improvement in terms and conditions of service. However, according to the wording of the clause, that would be allowed.
However, the great thing is that we are not saying that people shall not carry on their service as private practitioners. We are saying that they will not carry it out over a period of time in the NHS. They will be able to be fully free to carry on outside the NHS and to earn their emoluments in that way if they so desire. Indeed, they will not be deprived of an opportunity of working in the NHS till reasonable alternative facilities are available outside the NHS.

Mr. Paul Dean: I am obliged to the hon. Gentleman for giving way. I should like to wish him well in his new appointment—although not of course, a long time in it. The point that I was trying to make to him is that it will be much more difficult when the private sector and the NHS sector are divorced from each other for the part-time consultants to be able to give proper service to both types of patients, that the Bill is creating a dilemma for them, and that there will be loss as a result of this. Where loss is proved, the Government should respond.

Mr. Moyle: The hon. Gentleman may well believe that, but as far as I can gather, from talking to consultants, consultants do not believe that. They believe that there is a tremendous demand for private facilities in health. Therefore, they should have absolutely no difficulty, given a reasonable period of notice—which is essential. I agree—in transferring their employment to private facilities outside the NHS. On that point, I do not accept what the hon. Gentleman has said.

Mr. Patrick Jenkin: I join my hon. Friend in welcoming the Minister to his post. The Minister is laying great stress on the freedom, which the Bill enshrines, for the consultant to carry on his independent practice outside the NHS. Presumably he is also envisaging that consultants will continue with a part-time consultancy within the NHS. Is he prepared to accept amendements at a later stage, amendments which were resisted in Committee, which would link the availability of accommodation outside the NHS, for the purpose of phasing out pay beds, not merely to its availability and suitability for the patient but its availability and suitability for those who are practising within the NHS? Such amendments were resisted time and again in Committee, but the Minister's argument now says that they must be accepted.

Mr. Moyle: Not at all. I am arguing that given the situation that consultants seem to me to think exists, there is no need for the sort of provision for which the right hon. Gentleman has just been arguing, and I would resist that sort of amendment on the same grounds.
There are a number of other detailed difficulties in dealing with the plea for compensation argued by the hon. Mem-

ber for Somerset, North. The position of consultants has been fully discussed with representatives of the professions, including the British Medical Association and the British Dental Association.
First, a consultant who wishes to increase his commitment to the NHS as pay beds are phased out may protect his position by transferring from a maximum part-time contract to a full-time contract. That course is always available to him. My right hon. Friend the Secretary of State and we on the Government side of the House would welcome any number of consultants who are willing to do that.
The other thing is that, subject to the normal procedures of negotiation, it would be quite wrong to make in the Bill a provision which would allow the board to interfere in the normal processes of negotiation by which terms and conditions of service in the NHS are laid down. That applies particularly to the provision that says that a person may obtain more advantageous conditions of service in his NHS employment. There is proper Whitley Council machinery throughout the NHS for negotiation of these terms and conditions of service freely between the authorities, on the one hand, and the trade unions and the associations, on the other hand.
No National Health Service employee will lose pay or emoluments due to him under his NHS contracts because of the Bill. No Government can be expected to guarantee part-time consultants against what may be hypotheical loss of income simply because Parliament has decided to separate private practice from NHS hospitals and not to prevent it. That is the important thing. It is to separate it and not prevent it. If separation is to be achieved in an orderly manner, then reasonable time will be allowed to ansure that people whose financial interests are affected will have sufficient notice in order to adjust their financial circumstances to the situation. This is a built-in part of the Goodman proposals. The provisions in the Bill are entirely necessary and the new clause is entirely undesirable.
A great deal of consideration has been given to the problem of overmanning. One of the things I found particularly interesting about the proposal of hon. Members opposite is that people will be


taken into the NHS on more advantageous terms and conditions of service than they enjoy at the moment of phasing out, whether there is work for them in the NHS or not. That is not the normal sort of noise we expect to hear from the Conservative Party on the subject of providing jobs and overmanning, yet that is what this could easily turn out to be.
In those circumstances I therefore reject the addition of the new clause to the Bill.

Mrs. Knight: Shortly after the dark day when the Bill becomes law. I foresee the setting up of a new national society, the SPCMP—the Society for the Prevention of Cruelty to the Medical Profession. I am amazed that the Minister is so blind to the points made by doctors in their arguments against the Bill and of the very detailed points they raise such as the ones covered in the new clause so ably moved by my hon. Friend the Member for Somerset, North (Mr. Dean).
The Minister said that the matter had been discussed. It may have been discussed, but I would lay any money that it was not agreed. It is perfectly true to say that any trade unionist would not be satisfied by mere compensation for loss of employment or loss of office. Any trade unionist would be quite right to say that if this House passed legislation which directly led to a drop in his salary, he had every right to complain to this House and expect that the salary would be made up. There is no doubt whatsoever that it would be made up, and damned quickly too.
The Minister also went on to say that it was perfectly open to any doctors who found themselves in the unhappy position of having to take a drop in salary because of the Bill to take on full-time contracts. I have a letter in my hand from a professor at the University of Birmingham Department of Surgery, the Queen Elizabeth Hospital. It is right that the Minister should hear what he has to say about that suggestion.
I quote:
I think that economic considerations would force many of my colleagues to become whole time and I think to do this under a sense of financial duress would not be in the best interests of the National Health Service and it will be deeply resented by many people forced into this situation for what

are overt political reasons. It will in fact lead to the introduction of a whole time salaried service for very many of these colleagues no matter how loud the protestations of the politicians are to the contrary.
What the Government ought to learn—but I am sorry to say that I see absolutely no sign or inclination of their learning—is that the NHS cannot and will not be able to function properly if we do not have the good will of the doctors who work in it.
10.0 p.m.
I should like to draw to the attention of the House the comments of four doctors, most of them junior hospital doctors, when confronted with this situation. One house officer, post-registration, says:
I suppose I do about 108 hours a week. I believe in traditional British medicine, but I am increasingly worried at the way the Government is interfering with the way we practise. We face more and more restrictions, a limiting of hospital facilities and attempts to direct our prescribing. Meanwhile, more and more money is ploughed into administration. The patient must come first, but if the Government continues to curtail our freedom and I find I can no longer serve the sick public then I shall go abroad.
That is precisely the sort of situation which might be facing any young doctor or consultant after the Bill is passed. In continuing roaring inflation, he will be expected to take a cut in salary. The Government take no responsibility for that although it is directly their responsibility.
A young woman doctor said:
I do not want to be forced into general practice or to emigrate. I still want to become a consultant—but I can predict nothing with a Government which makes a promise today and breaks it tomorrow.
[An HON. MEMBER: "Nonsense."] Those are not my words. Those are—[Interruption.] In a debate of this kind—

Mr. Speaker: Order. If anyone wishes to intervene, there is a well-known procedure for doing so—to get up and ask leave to intervene.

Mrs. Knight: I am grateful, Mr. Speaker. When we are dealing with subjects so close to the hearts and livings of our constituents in the medical profession, surely it is right to purvey their words to the House.
The third doctor said:
I am so disillusioned that I have given up my original burning ambition to have a consultancy of my own.
The Bill makes that a very difficult decision.
The fourth doctor says:
The entire pay structure is wrong. A senior registrar can earn up to £9,000 a year with overtime…and get paid £1,500 a year less if he is promoted to a consultancy.
If, on the passage of the Bill, he finds his salary reduced still further, he will be in a difficult position if the new clause is not accepted.
Whatever we do here in our arrogance and deafness, I beg the House to realise that we must accept that, unless we act in the best interests of those who serve us in the National Health Service, even part-time—there is nothing disgraceful about that—the whole of the service which we can provide for sick people will be at risk.

Mr. Crouch: If I am interrupted, either from a seated position or properly, it will probably be from my own side, because I do not feel entirely sympathetic with the new clause moved so wisely and clearly by my hon. Friend the Member for Somerset, North (Mr. Dean).
I, too, welcome the Minister of State to his appointment. I am sure that he will bring to it much constructive thought and sympathy, which is what it needs. He has exposed something which is harmful to the whole Bill. The new clause would provide that compensation should be paid to anyone working in the service who found himself worse off because of the Bill. The Minister said, "But I am assured that consultants will find plenty of remunerative employment in the private sector." The implication was that they would do much better than before as part-time personnel in the NHS, using NHS facilities, and part time in the new private sector which the Government are creating.
That is what disturbs me most of all. The Bill is creating a new force in medicine. It is a small cloud at present, but it is a most dangerous cloud which is coming over the care of the sick. It is created out of the good will, the good intentions and the zeal and devoted attention of strong Socialist feeling which is determined to get the Bill through. Yet

that will create something which will give part of the service to the private sector and part to the public sector. If the Minister of State is right and consultants find that the private sector pays better than the National Health Service, the drain will begin of the quality of service that we get from all those who are valuable in the National Health Service.
It is perhaps strange for a Conservative to contrast private with public in this somewhat derogatory manner, but we have a fully-established National Health Service which we want to sustain and maintain and which we want to grow from strength to strength. That is the Opposition's view and I feel it strongly. It is the conclusion that a new Minister of State draws from this interesting suggestion which I do not believe is absolutely necessary because of the hint given by the Minister—namely, that the private sector will prove attractive. That is the danger, and I do not want that to happen.

Mr. Ennals: I regret having to interrupt an hon. Member who is arguing on my side, but I wish to clear up any misunderstanding. All I was doing was reporting to the House views which had been put to me. In explaining any consequences, I do not see how those views can be used as the basis for a claim for compensation.

Mr. Crouch: Those views cannot be used as the basis for a claim for compensation. That is why I am not fully sympathetic to the new clause.
I use the debate to make a point which has worried me for a long time. My point is important. I am glad of the opportunity to discuss it and grateful that my hon. Friend's proposal has drawn that concern from me. I hope that the Secretary of State will bear it in mind. I am sure that he does not wish to see a migration of people from the National Health Service either into the private sector or abroad. It is perhaps schizophrenic, but I accept the argument that lack of compensation could be the last straw which persuades people to move.
We must not make over-emotional arguments about the problems, but they are real. There are many reasons why someone might feel that he should seek his fortune elsewhere. There are the economic and social reasons and the


frustration which is felt today in our country, which has fathered so much of value in medicine and the care of the sick. This small Bill could create something much bigger in terms of danger to the service which is so important to our people.

Mr. A. P. Costain: I know that my hon. Friend is much more experienced in hospital administration than I am. Will he help me? The consultants who saw me on this matter are worried because, they say, when they have operated on a private patient in a public hospital they are able to visit ordinary National Health Service patients following that operation. If they are forced by the Bill to operate in private nursing homes, they will not have the same opportunity to slip in and out to see their NHS patients. What is the answer to that?

Mr. Crouch: I accept that argument. It is the dilemma with which consultants will be faced. They will have to decide whether to become full time in the NHS because they want to give devoted service to their patients. Only one hon. Member today has said that some men and women in medicine put politics before patients. I have never met such persons. No doubt they exist somewhere, but I have not met any of them.
When my wife went into Guy's Hospital for a major operation two years ago, the professor of surgery there said "I would rather have you in a public ward because you will get better attention there, and I will see you more often than if you go to the Nuffield home." The facilities around the NHS beds in Guys are better 'than in private rooms. But that is another point. It is so easy when one gets worked up about the Bill to make Second or Third Reading speeches when one should not do so.

Mr. Kilroy-Silk: If facilities are so superior in public wards, why is there all the fuss about eliminating private beds from NHS hospitals?

Mr. Crouch: We are making a fuss now, but the Labour Party started it. The hon. Gentleman is still short of experience in this House. I have a certain affection for him. He is sitting in

a seat usually reserved for former Prime Ministers. He declared before he came to the House that he wanted to be Prime Minister. But I think that he should move back a little now, because he is apt to make me stray from the point I am trying to make. However, I shall answer his question, but first I want to answer the question raised very properly by my hon. Friend the Member for Folkestone and Hythe (Mr. Costain)namely, whether there will be disadvantage in the future because the part-time consultant will have the problem of how to split his time economically between an NHS hospital and a private hospital or nursing home.
Many consultants will have to choose whether to be whole-time in the NHS or to pack it up completely. That is what worries me. This is where I come back to the question of compensation. If a consultant chooses to become whole-time in the NHS he could be disadvantaged by the Bill, with his income reduced. Therefore, the new clause has some force in it which I can understand.
Of course, the consultant could make another decision. If he found himself disadvantaged by losing a certain amount of income in going full-time in the NHS, no longer treating private patients, I fear that he might go out of the NHS altogether. We could lose good men and women in that way. This applies not only to consultants but to nurses, anaesthetists, ancillary workers and even porters.
I am worried about the prospect, I know of plans in my constituency for large country houses to be used as new private hospitals. I deride such suggestions. I do not like them.

Mr. Ennals: I am grateful to the hon. Gentleman for giving way to me, but as I appointed him to an area health authority perhaps I have a right to interrupt. Does he not think it likely that a considerable number of consultants are likely to become whole-time instead of maximum part-time? If that is so, even if it is only marginal, it will help to reduce the waiting lists within the NHS. I understand the hon. Gentleman's fear that there might be a movement to set up a larger private sector which would challenge the NHS, but in that case does he not think that we are right to bring


in legislation to impose a certain limit on the size of growth of the private sector to avoid creating such damage?

10.15 p.m.

Mr. Crouch: That is the very part I dislike so much. While I can go along with the right hon. Gentleman in saying that we must preserve the National Health Service, it must not be done at the diktat of even the Secretary of State. That is not the way I want the country run. That is the worst form of comporate State, the worst form of soviet State. [HON. MEMBERS "0h."] I am not using words extravagantly. I am very worried, because the Secretary of State and the Government want to achieve these tiny ends, getting rid of the private sector, and they say that they must take strong measures, as are proposed in the Bill, to ensure that the private sector does not grow. That is dictatorial, the Government taking to themselves a "Big Brother" attitude and saying, for example, that they will not want to see a building in my constituency made into a private hospital, and they will dictate that it shall not happen.

Mr. Ennals: It is accusations of that kind about dictatorship, again from a member of a regional health authority, which I find so disturbing. We have decided to establish—it is in the Bill—an independent board with an independent chairman. [An HON. MEMBER: "Rubbish"] It is not rubbish. It will be done not by some "Big Brother" taking decisions but with an independent board taking those decisions. That is the essence of it.

Mr. Crouch: All right, that is the essence of it; but at the end of the line the board will report to the Secretary of State, who will make the decision.

Mr. Ennals: No.

Mr. Crouch: I think that I understand the matter correctly. However, we are straying, and I shall say no more about that.
I am concerned that as a result of the Bill there will be a migration of good men and women out of the National Health Service into the private sector, and some even overseas. This is the pity of it. The Government have a fall-back and they say that they will stop that from

happening. There are important, strong clauses in the Bill. The Secretary of State says that it will be decided by a board. Very well. That is the limit of democracy in the Bill. Eventually it comes to Whitehall. That is what worries me.
The Secretary of State says that it is strange that a member of a regional health authority should use such words as "dictatorship". Why should not a member of a health authority who is also a Member of Parliament talk about dictatorship when dictatorship is written into the Bill?

Mr. Ennals: I am grateful to the hon. Gentleman for giving way again. I was in no way challenging his right to criticise, but I am disagreeing with what he said. He understands the Bill. Surely he will recognise that the Secretary of State already has power, if he chooses to use it, to end pay beds. Steps have been taken previously by Secretarys of State to reduce the number of pay beds. They are at the discretion of the Secretary of State. In fact, the Bill takes power away from the Secretary of State and gives it to an independent board, establishing certain criteria. I do not understand how one can call that dictatorship.

Mr. Crouch: I have given way to the Secretary of State several times, and this is a good debate. The right hon. Gentleman has been rising to his feet, speaking without a note and from his heart and his head on this matter. We are learning a lot. [An HON. MEMBER: "Has he a head?"] He would not have reached his present office by using his heart alone.
The Bill is much bigger than we may now imagine it to be. It has within it ingredients that can destroy the National Health Service as it is today. It should be the intention of Parliament, of men and women of good will in all parties, large and small, to ensure that we do nothing to weaken the National Health Service. I believe, however, that there are in the Bill—I speak passionately as a supporter of the National Health Service —elements that could produce a weakening of the service.

Mr. Patrick Jenkin: It is right that we should have devoted a little time on Report to what is still regarded by the


profession, despite everything the Minister of State said about the consultations he has had, as a matter of considerable importance. He may have unwittingly misled the House when he seemed to suggest—I wrote down his words carefully—that the consultants did not think that there was any need for this provision. I ask him to return to the BMA and see whether it thinks there is any need for it. I think that if he consults the records in his Department he will be able to satisfy himself that he has far from allayed the anxieties of those who represent the consultants in the hospitals about the damage that will flow from the Bill.
The Minister used a number of arguments to justify the absence of any right of compensation. The first was that the consultant would be free to carry on his private practice outside the NHS. In the light of our debates on a number of clauses in Committee he cannot rely on that argument. The Government have consistently resisted any attempt to build into the criteria or the phasing out of pay beds the fact that the facilities outside the health service should be reasonably available to the practitioner. Where reasonable availability has to be a criterion, the Bill refers throughout to the patient. For example, Clause 4(7)(b) says
are otherwise reasonably available (whether privately or at NHS hospitals) to meet the reasonable demand for them".
That demand is demand by the patient. Clause 8(2) says:
is not privately available there at a place which is reasonably accessible to the patient".
In Committee we gave a number of examples of where the difficulty would be overcome for the patient because for a particular speciality he might reasonably be expected to travel a considerable distance, but where it would be impossible for a part-time consultant. I gave the example of a NHS part-time consultancy in Bristol, with the nearest facility providing private practice in Exeter. It would be reasonable for the patient to be expected to go to Exeter rather than Bristol, but it would be impossible for the consultant to mix his practice by doing part of it in Bristol and part in Exeter. It is in those circum-

stances that the need for compensation will arise.
The Minister took refuge in the argument that the consultant could transfer to a full-time contract. He used those words quite unqualified. In the debate on the new clause in Committee his predecessor, the right hon. Member for Plymouth, Devonport (Dr. Owen), stressed:
subject always to the needs of the service". —[Official Report, Standing Committee D, 3rd August 1976; c. 1577.]
The question is what is to happen to the consultant where the needs of the service do not require a further full-time consultancy and yet he is precluded from carrying out an independent practice. He will be stuck with a part-time consultancy or with the option of abandoning it and moving to another part of the country, where he can, perhaps, combine the NHS with an independent practice—or of emigrating, as my hon. Friend the Member for Somerset, North (Mr. Dean) said.
It is not only a question of need. It will increasingly be a question of resources. My hon. Friend the Member for Ealing, Acton (Sir G. Young) has drawn my attention to an answer given by the Minister of State's predecessor last year, when he said:
The notional cost of all part-time and maximum part-time consultants taking up whole-time employment in the NHS would be about £13 million a year in England and Wales excluding any consequential adjustments to distinction award payments."—[Official Report, 9th December 1975; Vol. 902, c. 163-4.]
That was one of the bases upon which we arrived at the figure of £40 million as the cost of implementing the Bill when it takes full effect, but the £13 million, as an additional burden on the health service, is a very substantial amount indeed.
If an area or region is confronted with all the various demands which are now being made, and if the option of going full-time is one that it might be prepared to offer a consultant, but it is not of the highest priority, it might say, "Yes, there is a need but we cannot afford it, and you will have to stay part-time". What is to happen to that consultant if pay beds are phased out on the ground that there is an alternative facility reasonably available for the patients but no reasonable opportunity for him to practise? This seems to me to be a very strong case indeed.
The Minister of State then argued that there would be a considerable growth of practice outside the National Health Service. I do not want to get involved in the argument put by my hon. Friend the Member for Canterbury (Mr. Crouch). On this issue I happen to share his view and belief that it will not be a good thing in the long run if we have two services existing side by side—a thriving, prosperous, well-financed private service, and a struggling, under-financed, increasingly shabby National Health Service. I do not believe that that will be viable or desirable. I shall have something more to say about that when we come to Third Reading tomorrow.
If we do not get the growth of the private sector, why should there not be some right of compensation for the consultants who will suffer a serious detriment to their position as a result of the Bill? If that view is right, and there are ample opportunities outside the National Health Service, it will cost the Government nothing to include the clause, because there will be no demand for it. If the Government are wrong and there will not be a thriving, booming private sector outside which will snap up the consultants who are no longer able to practise privately in National Health Service hospitals, it seems to me that it is incumbent on them to provide this right to compensation.
My hon. Friend the Member for Somerset, North said that there were ample precedents for this, and I shall quote only two of them. The Minister of State will recollect that in the 1946 Act general practitioners were deprived

of their right to buy and sell practices and that a lump sum of £66 million was provided in the Bill to be paid out as compensation for the loss of the rights that the Bill took away from them.

Another example, not in the National Health Service but not wholly inappropriate, is to be found in the Acts dealing with local government reorganisation. I was concerned with London in 1963. There were very sophisticated rights indeed in the case of any local government officer who lost his job or had his prospects seriously harmed. I had a case where a man had to fight for about 10 years before he was finally able to establish his rights under the London Government Act 1963 to compensation, because the change which Parliament had enforced had deprived him of the expectation of promotion. That is the particular point that the Minister of State mentioned.

It is in these circumstances that we should consider the position of a consultant who has his pay beds taken away and is deprived of the right to carry on independent practice on which he has relied for a substantial slice of his income. If there is no opportunity open to him—and that is what the clause says—compensation should be offered to him.

In these circumstances, I think that the new clause is perfectly reasonable and I would have thought it wholly right that my right hon. and hon. Friends should divide the House in favour of it.

Question put, That the clause be read a Second time:—

The House divided: Ayes 137, Noes 185.

Division No. 315.]
AYES
[10.30 p.m.


Atkins, Rt Hon H. (Spelthorne)
Cooke, Robert (Bristol W)
Gow, Ian (Eastbourne)


Awdry, Daniel
Cope, John
Gower, Sir Raymond (Barry)


Bennett, Dr Reginald (Fareham)
Cordle, John H.
Grant, Anthony (Harrow C)


Benyon, W.
Cormack, Patrick
Gray, Hamish


Bitten, John
Costain, A. P.
Grieve, Percy


Blaker, Peter
Craig, Rt Hon W. (Belfast E)
Griffiths, Eldon


Body, Richard
Crouch, David
Grist, Ian


Boscawen, Hon Robert
Dean, Paul (N Somerset)
Grylls, Michael


Bottomley, Peter
Dodsworth, Geoffrey
Hell, Sir John


Boyson, Dr Rhodes (Brent)
Douglas-Hamilton, Lord James
Hall-Davis, A. G. F.


Brocklebank-Fowler, C.
Eden, Rt Hon Sir John
Hamilton, Michael (Salisbury)


Brown, Sir Edward (Bath)
Fairbairn, Nicholas
Hannam, John


Buchanan-Smith, Allck
Fairgrieve, Russell
Harvie Anderson, Rt Hon Miss


Buck, Antony
Fell, Anthony
Hayhoe, Barney


Bulmer, Esmond
Fisher, Sir Nigel
Hicks, Robert


Burden, F. A.
Fletcher-Cooke, Charles
Hordern, Peter


Carlisle, Mark
Fookes, Miss Janet
Hunt, David (Wirral)


Chalker, Mrs Lynda
Forman, Nigel
Hunt, John (Bromley)


Clark, Alan (Plymouth, Sutton)
Fowler, Norman (Sutton C'f'd)
Hurd, Douglas


Clarke, Kenneth (Rushclitle)
Gardiner, George (Relgate)
Hutchison, Michael Clark


Clegg, Walter
Gilmour, Rt Hon Ian (Chesham)
James, David




Jenkin, Rt Hon P. (Wanst'd &amp; W'df'd)
Moore, John (Croydon C)
Silvester, Fred


Johnson Smith, G. (E Grinstead)
More, Jasper (Ludlow)
Sims, Roger


Jopling, Michael
Morgan-Giles, Rear-Admiral
Sinclair, Sir George


Kaberry, Sir Donald
Morrison, Hon Peter (Chester)
Speed, Keith


Kershaw, Anthony
Mudd, David
Spence, John


Kilfedder, James
Neave, Alrey
Sproat, Iain


Kimball, Marcus
Neubert, Michael
Stanbrook, Ivor


King, Tom (Bridgwater)
Newton, Tony
Stewart, Ian (Hitchin)


Kitson, Sir Timothy
Nott, John
Stradling Thomas, J.


Knight, Mrs Jill
Page, Rt Hon R. Graham (Crosby)
Taylor, R. (Croydon NW)


Knox, David
Parkinson, Cecil
Taylor, Teddy (Cathcart)


Latham, Michael (Melton)
Percival, Ian
Tebbit, Norman


Lawrence, Ivan
Prior, Rt Hon James
Vaughan, Dr Gerard


Le Marchant, Spencer
Pym, Rt Hon Francis
Wakeham, John


Lester, Jim (Beeston)
Raison, Timothy
Walder, David (Clitheroe)


Luce, Richard
Rathbone, Tim
Wall, Patrick


McCrindle, Robert
Rees, Peter (Dover &amp; Deal)
Weatherill, Bernard


Macfarlane, Nell
Rifkind, Malcolm
Whitelaw, Rt Hon William


Marshall, Michael (Arundel)
Rippon, Rt Hon Geoffrey
Winterton, Nicholas


Marten, Neil
Roberts, Wyn (Conway)
Wood, Rt Hon Richard


Maxwell-Hyslop, Robin
Rost, Peter (SE Derbyshire)
Young, Sir G. (Earing, Acton)


Meyer, Sir Anthony
Sainsbury, Tim
Younger, Hon George


Miller, Hal (Bromsgrove)
Scott, Nicholas



Mills, Peter
Shaw, Giles (Pudsey)
TELLERS FOR THE AYES:


Mitchell, David (Basingstoke)
Shepherd, Colin
Mr. Anthony Berry and


Monro, Hector
Shersby, Michael
Mr. Carol Mather.


NOES


Allaun, Frank
Evans, loan (Aberdare)
MacFarquhar, Roderick


Anderson, Donald
Ewing, Harry (Stirling)
McGuire, Michael (Ince)


Archer, Peter
Faulds, Andrew
Mackintosh, John P.


Ashton, Joe
Fernyhough, Rt Hon E.
McMillan, Tom (Glasgow C)


Atkins, Ronald (Preston N)
Flannery, Martin
Madden, Max


Atkinson, Norman
Fletcher, L. R. (Ilkeston)
Mahon, Simon


Bagier, Gordon A. T.
Fletcher, Ted (Darlington)
Marks, Kenneth


Bain, Mrs Margaret
Foot, Rt Hon Michael
Marquand, David


Barnett, Guy (Greenwich)
Ford, Ben
Marshall, Dr Edmund (Goole)


Bates, All
Forrester, John
Marshall, Jim (Leicester S)


Beith, A. J.
Fraser, John (Lambeth, N'w'd)
Maynard, Miss Joan


Benn, Rt Hon Anthony Wedgwood
Freeson, Reginald
Meacher, Michael


Bishop, E. S.
George, Bruce
Mendelson, John


Blenkinsop, Arthur
Golding, John
Morris, Charles R. (Openshaw)


Boardman, H.
Gould, Bryan
Moyle, Roland


Booth, Rt Hon Albert
Gourlay, Harry
Murray, Rt Hon Ronald King


Bray, Dr Jeremy
Grant, George (Morpeth)
Noble, Mike


Brown, Hugh D. (Provan)
Grant, John (Islington C)
Ogden, Eric


Brown, Robert C. (Newcastle W)
Grimond, Rt Hon J.
Orbach, Maurice


Brown, Ronald (Hackney S)
Grocott, Bruce
Orme, Rt Hon Stanley


Buchan, Norman
Hamilton, James (Bothwell)
Park, George


Buchanan, Richard
Hardy, Peter
Parker, John


Callaghan, Jim (Mlddleton &amp; P)
Harper, Joseph
Pavitt, Laurie


Campbell, Ian
Harrison, Walter (Wakefield)
Pendry, Tom


Cant, R. B.
Hatton, Frank
Panhallgon, David


Carmichael, Nell
Heffer, Eric S.
Reld, George


Castle, Rt Hon Barbara
Henderson, Douglas
Richardson, Miss Jo


Clemitson, Ivor
Hooson, Emlyn
Roberts, Albert (Normanton)


Cocks, Michael (Bristol S)
Howell, Rt Hon Denis (B'ham, Sm H)
Roberts, Gwilym (Cannock)


Cohen, Stanley
Howells, Geraint (Cardigan)
Robinson, Geoffrey


Colquhoun, Ms Maureen
Hoyle, Doug (Nelson)
Roderick, Caerwyn


Conian, Bernard
Hughes, Rt Hon C. (Anglesey)
Rodgers, George (Chorley)


Cook, Robin F. (Edin C)
Hughes, Robert (Aberdeen N)
Rooker, J. W.


Corbett, Robin
Hughes, Roy (Newport)
Roper, John


Cox, Thomas (Tooting)
Hunter, Adam
Rose, Paul B.


Craigen, J. M. (Maryhill)
Irving, Rt Hon S. (Dartford)
Ross, Stephen (Isle of Wight)


Cronin, John
Jackson, Miss Margaret (Lincoln)
Ross, Rt Hon W. (Kilmarnock)


Crowther, Stan (Rotherham)
Jay, Rt Hon Douglas
Rowlands, Ted


Cryer, Bob
Jenkins, Hugh (Putney)
Ryman, John


Cunningham, G. (Islington S)
John, Brynmor
Short, Mrs Renée (Wolv NE)


Cunningham, Dr J. (Whiteh)
Johnson, James (Hull West)
Silkin, Rt Hon S. C. (Dulwich)


Davidson, Arthur
Jones, Alec (Rhondda)
Silverman, Julius


Davies, Bryan (Enfield N)
Jones, Barry (East Flint)
Skinner, Dennis


Davies, Ifor (Gower)
Jones, Dan (Burnley)
Small, William


Deakins, Eric
Kilroy Silk, Robert
Smith, Cyril (Rochdale)


Dempsey, James
Lambie, David
Smith, John (N Lanarkshire)


Doig, Peter
Lamond, James
Spearing, Nigel


Dormand, J. D.
Leadbitter, Ted
Spriggs, Leslie


Duffy, A. E. P.
Lestor, Miss Joan (Eton &amp; Slough)
Stallard, A. W.


Dunn, James A.
Lewis, Ron (Carlisle)
Stoddart, David


Eadie, Alex
Lipton, Marcus
Strang, Gavin


Edge, Geoff
Loyden, Eddie
Swain, Thomas


Edwards, Robert (Wolv SE)
Luard, Evan
Taylor, Mrs Ann (Bolton W)


Ellis, John (Brigg &amp; Scun)
Lyons, Edward (Bradford W)
Thomas, Dafydd (Merioneth)


Ennals, David
McDonald, Dr Oonagh
Thomas, Ron (Bristol NW)


Evans, Gwynfor (Carmarthen)
McElhone, Frank
Thompson, George




Thorne, Stan (Preston South)
Welsh, Andrew
Wise, Mrs Audrey


Tlnn, James
White, Frank R. (Bury)
Woof, Robert


Urwln, T. W.
White, James (Pollok)
Young, David (Bolton E)


Wainwright, Edwin (Dearne V)
Wigley, Dafydd



Walker, Harold (Doncaster)
Wilson, Alexander (Hamilton)
TELLERS FOR THE NOES:


Walker, Terry (Kingswood)
Wilson, Gordon (Dundee E)
Mr. Ted Graham and


Weetch, Ken
Wilson, William (Coventry SE)
Mr. Donald Coleman

Question accordingly negatived.

Clause 1

THE HEALTH SERVICES BOARD AND ITS COMMITTEES

Mrs. Knight: I beg to move Amendment No. 1, in page 1, line 10, leave out 'five' and insert 'seven'.

Mr. Deputy Speaker (Sir Myer Galpern): With it we may take the following amendments:
No. 67, in Schedule 1, page 25, line 14, at end insert:
'(d) two other persons representing the interests of patients who wish to undergo medical treatment privately.'
No. 68, in page 25, line 21, leave out
'one or other of the national health services'.
No. 69, in page 25, line 23, at end insert—
'(3) In appointing all the members of the Board the Secretary of State shall, so far as is practicable, ensure that they will have as their sole concern the interests of hospital patients generally, and not the interests of any other group or class of persons.'

Mrs. Knight: The amendments seek to provide, first, that the board shall have seven members instead of five; secondly, for two other persons to represent the interests of private patients. They also seek to determine beyond what we already know precisely what is meant by the wording of Schedule 1:
(b) such bodies not falling within paragraph (a) above as the Secretary of State may recognise as being representative of persons employed in one or other of the national health services or concerned with the interests of patients at NHS hospitals.
It is far from clear what is meant by those words. Although we asked the Minister in Committee, we did not receive a satisfactory reply. The concept appears to be divisive. As no clear answer was given in Committee the amendment has been moved now. I trust that we shall have a clearer answer on this occasion.
10.45 p.m.
Amendment No. 69 is of great importance. We believe that there has been far too much interest and notice paid to other groups in this matter and far too little attention paid to the possible detrimental effect on patients as a result of what we are doing.
The case for extra members on the board is overwhelming. I doubt whether hon. Members have appreciated the vast number of duties which the Bill places on the shoulders of the board. It will have to check that reductions in all areas are being carried out according to the rules that are set out clearly in the Bill. It will have to investigate and submit plans for progressive revocation in accordance with Clause 4. That will be very much a continuing process. The Bill will involve careful scrutiny of all areas. Already in the health service there is far too little care and proper scrutiny given when cases are being made out.
A matter that reached my attention recently involved the children's hospital in Birmingham. It
was found that very many more facilities needed to be made available. It is the second children's hospital in Britain. It covers a wide-ranging catchment area. It was reckoned in the early 1970s that the hospital needed to provide for 100 open heart operations a year and that the staff, especially the intensive care unit staff, should be geared to that number of operations. In fact, it has been found that the need is exactly double that estimate. It has been found that there needs to be at least 200 open heart operations. There are already most distressing cases of children who need heart operations who are not able to have them at present because of a shortage of staff.
I was told on a recent visit to the hospital that an application had been made for more staff to carry out the necessary duties. The request was put through the normal procedure and it was turned down flat with no one even visiting the hospital, no one even going to inquire why the children needed the extra members of staff.
That is the sort of thing that must now happen many times over in the health service. Applications are turned down by some distant administrator who does not even take the trouble to go to the hospital, examine the waiting lists, talk to the consultants and assess the real need.
Under the Bill responsibility is placed quite clearly on the board. It would be wrong if we were to fail to appreciate the extensive duties that the Bill places


on the board. It seems extraordinary to expect that five people will be able actively and properly to carry out all the duties laid upon them. The board will have to take account of all the difficulties that might be experienced by all hospitals after private patients are phased out. For example, it will have to give consideration to the case that is made by a hospital that its teaching programme will be adversely affected. That is a matter that the board will have to study.
The board will also have to consider research work. I do not know how many hospitals there are in Great Britain, but the board will have wide and extensive duties. It will be blamed if facilities deteriorate after the Bill becomes law and we must make the board big enough to cope with the duties we impose on it.
The board will also have to check that admissions to hospital are on medical grounds alone. We have heard a great deal of rubbish about waiting lists. Hon. Members opposite have ridden this old horse until it is almost dead on its feet. They will never accept the truth that no person in desperate need of medical care has ever been unable to get it because a private patient has been occupying a bed. No evidence has ever been provided to disprove this fact.

Mrs. Renée Short: If the hon. Lady says she has seen no evidence, she must have read the evidence to a recent Select Committee with her eyes closed. Cases were quoted by people working in hospitals and general practitioners said that they had patients in need of urgent operations who were having to wait.
The hon. Lady is being prompted now by the hon. Member for Reading, South (Dr. Vaughan) who sat on that Committee. If she says that no patient in urgent need of a serious operation has ever had to wait, she must have been reading the evidence with her eyes closed.

Mrs Knight: What I have said is true. The evidence to which the hon. Lady refers was never substantiated. I have checked.

Mrs. Renée Short: With whom?

Mrs Knight: I shall talk to the hon. Lady afterwards if she wishes. She is

well aware that there has never been a substantiated case of a sick person in desperate need of medical attention being unable to get it because a private patient occupied a bed.
It is extraordinary how some people refuse to see the truth even when it is in front of their face. No one on this side of the House would accept for a moment a situation in which a person needing desperate medical care was denied it because of private patients, but it simply does not happen. What does happen is that social considerations frequently have to be taken into account in admissions to hospital. For example, teachers may need to be admitted during school holidays or mothers admitted at times when their children can be cared for properly.

Mrs. Renée Short: Wealthy mothers.

Mrs. Knight: The hon. Lady may talk about wealthy mothers if she wishes. I am talking about ordinary working-class mothers like me who need care. We are all working class today. The hon. Lady perhaps had staff to look after her children if she needed care. I have not had that benefit. I am talking about mothers who need to make specific arrangements for their children to be taken into care and therefore have to ask the NHS to take them into hospital at a certain time. We discussed this matter in Committee. Some Labour Members recognised that there was often good reason to override the clear medical priority because of social considerations.

Mr. Boscawen: My hon. Friend is correct. It is done time and again every day in every hospital.

Mrs. Knight: This debate has illustrated the task that we are placing on the board in this regard. The first time that anyone finds that Mrs. So-and-So has been in hospital before Mrs. Such-and-Such, they will have to complain to the board. The duties that we are giving the board are extremely wide and difficult to cope with.

Mr. Ennals: I cannot see the relevance of the hon. Lady's remarks to whether the board shall consist of five or seven members. It may be that I am a bit dim. The hon. Lady seems to be referring to the board as if it were taking over responsibility from the Secretary of


State for running the health service. I do not understand her logic.

Mrs. Knight: I am merely following and enumerating the duties which the Bill places on the board. If the Secretary of State will look at the Bill and recall the debates in Committee, he might realise that everything I have mentioned is in the Bill as being the duty of the board.
The board has a wide variety of duties to perform. When a board is given such duties, surely it is not outrageous to suggest that its membership should be enlarged to cope with the large number of duties that have to be performed. That is not unreasonable.
As well as looking at the specialist services—radiotherapy, diagnostic, pathological, and so on—the board members have to work on planning permissions and notifiable works. The Secretary of State will recall that we had an interesting and lengthy debate on notifiable works. Adjudication on what is a notifiable work is difficult.
On page 17 of the Bill—this is what makes this part of the board's duties difficult—we are told:
'hospital premises' means premises of any prescribed class, being premises used or to be used for the prevention, diagnosis or treatment of illness or for the reception of patients".
The difficulty is that any alteration to any premises so prescribed must come to the board for scrutiny. This is another reason why I beg the House and the Secretary of State to appreciate the variety of duties with which the board is being asked to cope.
Secondly, the number of persons is not sufficient. Above all, there ought to be at least one or, as I say, two other representatives on the Board, because there is no one on the Board to speak for private patients at all.
As I said in Committee, if a committee, a board or anything of that sort were to be set up to discuss matters vitally affecting trade unionists, their conditions of work, their freedoms or rights, I should be the first to go to the battlements and—

It being Eleven o'clock, further consideration of the Bill stood adjourned.

Bill, as amended in the Standing Committee, to be further considered tomorrow.

DIRECT ELECTIONS TO THE EUROPEAN ASSEMBLY

Ordered,
That Mr. Secretary Hattersley be discharged from the Select Committee on Direct Elections to the European Assembly and that Mr. Brynmor John be added to the Committee.—[Mr. Walter Harrison.]

RETIREMENT OF TEACHERS (SCOTLAND) BILL [LORDS]

Order for Second Reading read.

Motion made, and Question put, That the Bill be referred to the Scottish Grand Committee.—[Mr. Frank R. White.]

Whereupon not less than ten Members having risen in their places and signified their objection thereto, Mr. DEPUTY SPEAKER declared that the Noes had it.

Bill to be read a Second time tomorrow.

VALUATION AND RATING (EXEMPTED CLASSES) (SCOTLAND) BILL [LORDS]

Order for Second Reading read.

Motion made, and Question put, That the Bill be referred to the Scottish Grand Committee.—[Mr. Frank R. White.]

Whereupon not less than ten Members having risen in their places and signified their objection thereto, Mr. DEPUTY SPEAKER declared that the Noes had it.

Bill to be read a Second time tomorrow.

BOURNEMOUTH AND POOLE (ACCIDENT CENTRE)

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Frank R. White.]

11.2 p.m.

Mr. John Cordle: It is particularly apposite that I have to raise a matter in respect of the health services in my own division, the subject of casualty ward facilities at the Boscombe General Hospital. I am grateful for the opportunity of bringing to the attention of the House a matter which is causing very considerable concern and anxiety to my constituents. That is the centralisation of accident services at the Poole General Hospital.
The position until recently was that the Bournemouth-Poole area had two hospitals with accident facilities, one at Boscombe—the Royal Victoria Hospital—and the other at Poole: in other words, one at the eastern side of this urban area and the other at the western side. The arrangement was obviously sensible because ambulances with emergency cases never had a particularly long journey to reach the nearest hospital. The arrangement was satisfactory to the people of Bournemouth.
Unfortunately, recently that satisfactory state of affairs has ceased to exist. There has been a so-called centralisation of accident services on Poole and a withdrawal of those services from the Royal Victoria Hospital. Two factors have, apparently, contributed to this. They are difficulties in staffing and regional policies which favour the permanent centralisation of accident services with only one accident centre for Poole and Bournemouth, situated for the present at Poole and, upon completion of phase 2 of the Castle Lane Hospital, later at the new Castle Lane Hospital.
The decision to withdraw accident services from the Royal Victoria Hospital has caused a great deal of dissatisfaction in the area previously served by that hospital's accident department. I used the word "dissatisfaction", but perhaps I was putting the matter too mildly and it would have been more accurate to say that the decision has caused anger and anxiety, because it is seen to be a decision that places lives in jeopardy.
When dealing with accidents of all sorts it is not merely minutes that always matter but seconds that can be vital in many cases. Now, the man who suffers from a heart attack in Boscombe must face a journey right across Bournemouth to Poole, right through the centre of the town, and one is speaking of journeys of perhaps 20 minutes in the middle of winter, when traffic is comparatively light, and up to 40 to 50 minutes in the height of the busy summer season when the town is packed with holidaymakers.
According to the area health authority the number of persons seen by the accident and emergency department at Poole in 1976 who would have been treated at the Royal Victoria Hospital's department had that been open were: in January,

899; February, 942; March, 874; April, 1,172; May, 1,255; June, 1,310 and July, 1,496, giving a total number of 7,948. I do not have the figures for August and September but if one assumes that they were no higher than those for July, that would make a grand total of almost 11,000 people this year who have been forced to trek across the town for their accident and emergency treatment.
In my view, and I know that it is also the view of most of the medical staff in the district, and also of the vast majority of my constituents, there should be two accident centres in the Bournemouth and Poole area and that in the immediate future the accident department at the Royal Victoria Hospital should be reopened at the earliest possible moment. Let me therefore comment upon and deal with each of the two factors which have contributed to the decision to close that accident department. I shall deal first with the "policy" ground.
If it is indeed the policy of the area health authority to provide only one accident centre for the Bournemouth and Poole area, it is a thoroughly bad policy which should be and must be reversed. I do not doubt for a moment that there may be areas where a population of comparable size to that of Bournemouth and Poole could be properly and adequately served by one accident department. But the population of Bournemouth and Poole is spread over a very long front and the distance from west to east is accordingly too great for an urgent care case to be forced to make the journey.
In other words, the policy of only one accident centre is totally incompatible with the geography of the area. None of us here can alter the geography and, accordingly, the policy must be changed to produce something sensible and realistic for the area that actually exists. When the policy has been changed, one must then face the manpower problem.
The other factor influencing the decision to withdraw the accident service was the difficulty in staffing the Royal Victoria Hospital. In the long term, this difficulty can only be overcome by ensuring that all our doctors and nurses are properly remunerated for their arduous, exacting and responsible work and remunerated so that large numbers of them no longer feel the urge to emigrate in search of the


higher standard of living for themselves and their families that they feel they have earned.
However, in the short term let me suggest that there is a solution possible in the Bournemouth area. There are many retired doctors and nurses living in in Bournemouth and many, I am sure, would be prepared to offer their services on a part-time basis in order to enable the accident department at the Royal Victoria Hospital to be kept open. These persons would, I am confident, respond to any call for assistance in order that they might be able to assist their fellows in the area by sacrificing a day or two of their retirement each week. That solution might not seem the ideal one, but it is a far better solution than that presently adopted and called "centralisation".
Centralisation might be administratively neat and convenient but, unfortunately for administrators, the population of Bournemouth was not centralised and remains sprawled along the coastline. While the people are spread, so must the doctors be spread among them if they are to be able to perform their basic functions of saving life and alleviating suffering.
The total absurdity of the present situation can be seen only too clearly in an example which was given to me by Mr. Sparrowe, one of the doorkeepers in this House, when he heard that I was to raise this subject. I cannot do better than quote from his letter of 4th August this year:
On 5th June 1976 my mother, who was 66 years of age, was taken into Boscombe Hospital with heart trouble and was in the intensive care unit for two or three days. During the morning of the 18th, she was left alone in a bath which eventually got cold. As the bell failed to attract the attention of the staff, she decided to leave the bath on her own. During the attempt she slipped and hurt her back and arm. This was about 11.15 a.m. Eventually she was found by a member of the staff and she complained about pains in her arm and back. After X-rays were taken at Boscombe Hospital, it was found that her arm was broken. My sister was informed of the accident at 3.45 p.m. and told that my mother would be taken to Poole Hospital for the arm to be set. She arrived at Poole at about 6 p.m. where her arm was duly set. She finally arrived back in her ward at Boscombe at 10.20 p.m. During the whole of the day and for several days afterwards, my mother was in a shocked state, and since the accident never fully recovered. My mother passed away on 27th July.

That is not merely a tragic incident but illustrates the absurdity of the present situation. An accident at the hospital in Boscombe has to involve a journey to Poole for accident treatment. How can such a sequence of events be prevented? Surely the answer is simple and obvious—reopen the accident department at the Royal Victoria Hospital at once.

11.12 p.m.

The Under-Secretary of State for Health and Social Security (Mr. Eric Deakins): I am grateful to the hon. Member for Bournemouth, East (Mr. Cordle) for raising this matter. I am of course aware that some local people have expressed concern about the centralisation of accident and emergency services for the East Dorset Health District at Poole General Hospital, and the consequent reduction in the service provided at the Royal Victoria Hospital, Boscombe. Such concern is not unusual when a reorganisation of this kind takes place. I hope that what I say will help alleviate the anger and anxiety of his constituents which the hon. Member mentioned.
I can assure the hon. Member that the centralisation of facilities was designed to improve the accident service in the district. This particular development, which was brought fully into effect in January this year, was one of a series undertaken by the Dorset Area Health Authority with the aim of providing the best possible level of patient care in East Dorset within existing resources. There were full local consultations on the proposed developments in 1973 and, following its establishment in 1974, the East Dorset Community Health Council was consulted and gave its support. The council has since reconsidered the matter and confirmed its support.
The centralisation of accident and emergency services at Poole is in line with my Department's policy on accident and emergency services. This is derived from the report published in 1962 of a sub-committee of the Standing Medical Advisory Committee—the Platt Report. The basis of the Platt recommendations is that it is necessary in the patient's interest to concentrate accident and emergency services into major departments. The object is to ensure that there are available all the medical and nursing skills, the supporting services, and the equipment needed for expert diagnosis


and immediate life-saving treatment for injured patients and other emergency cases. A range of medical disciplines may be involved. It is not possible for every hospital to be staffed and equipped to the necessary high standard to deal with emergency cases, and concentration is therefore in the best interest of the patient with a serious injury or other emergency condition.
It is better for such a patient to be taken direct to a major department, even though this may involve a longer ambulance journey than to be taken to a nearer hospital which does not have the necessary skills available, and then have to be transferred to a hospital with a major department. I take on board that this is a coastal conurbation. The distance involved is about five miles. The Department commended the recommendations of the Platt Report to health authorities as a basis for planning the development of accident and emergency services, by way of a departmental memorandum in 1963. Further guidance, which supplemented the original advice, was issued in 1968.
In taking their decision to follow this guidance to centralise accident and emergency facilities for the benefit of patients in East Dorset, the health authorities were also mindful of increasing difficulty in recruiting and retaining the junior medical staff necessary to man the then existing departments at the Poole General and Royal Victoria Hospitals. Junior doctors have become increasingly selective about the specialty they adopt, particularly in terms of job satisfaction, training opportunities and career prospects. In the past the clinical supervision of the accident departments at the Poole General and Royal Victoria Hospitals was the responsibility of one orthopaedic surgeon who was engaged full-time in his specialty, and was therefore able to devote very little time to clinical supervision or teaching. In addition the junior doctors were obliged to spend a disproportionate amount of time treating trivial injuries which could be treated perfectly adequately by a general practitioner and which did little to improve their training and experience in dealing with serious injuries. This sort of pattern was typical of the traditional hospital accident department.
The centralisation of major accident and emergency services into a new improved department at Poole, and the treatment of minor accidents by general practitioner assistants at the Royal Victoria, has resulted in a vast improvement in the staffing. The appointment to the Department at Poole of a consultant specialising in accident and traumatic surgery was one of the first authorised in the country by my Department with the aim of providing a career structure and attracting more young doctors to this important specialty. The consultant at Poole is supported by a medical assistant, a registrar and a number of senior house officers.
The original accident department at Poole has been extended and improved and a new dental department has been added, together with an additional X-ray examination room. The minor accident unit remaining at the Royal Victoria Hospital is open from 9 a.m. to 4 p.m. every weekday. It is the area health authority's experience that most accidents in local industries, schools and on the beach occur between these hours. It may not be generally appreciated locally that at the Royal Victoria Hospital there will be, as there always has been, a reception area open 24 hours a day, seven days a week, for the admission of acute medical and surgical emergencies, with doctors from the medical, surgical and anaesthetic departments continuously and immediately available. This hospital has its own intensive care unit and coronary care unit for just such emergencies.
The reception area and emergency team will also be available for the emergency treatment of patients who are so severely ill that the doctor concerned or the ambulance crew involved consider that the journey to Poole General Hospital would endanger the patient's condition. I take on board the point about free access where that facility will be absolutely crucial and I understand the anxiety of the hon. Member's constituents. Such instances are extremely rare, but they occur in cases of drowning or severe blood loss. The telecommunications link between the central ambulance control and the hospital allows for early warning of the impending arrival of emergencies of this kind.
I have taken note of the hon. Gentleman's suggestion about the use of medical personnel, and I am sure that the area health authority will take it into account in any further consideration it gives to the problem. I hope that what I have said will enable the hon. Gentleman to reassure his constituents, whose anxieties

I understand, that the arrangements now in being will enable the health district to provide a better service for anyone who is unlucky enough to sustain a serious injury.

Question put and agreed to.

Adjourned accordingly at twenty-one minutes past Eleven o'clock.